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Author Topic: SEVERE patellofemoral arthritis. Post fracture/hardware removal  (Read 7587 times)

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Offline Mrs.W

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I am 10 yr post patella fracture and 1 yr post hardware removal. Severe post traumatic patellofemoral arthritis Went to surgeon today and was told there was NOTHING that could be done to help me! I am devastated. The pain keeps me up at night. I'm only 37. What now????

Offline Adobec

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #1 on: January 08, 2013, 05:49:13 AM »
I would get a second opinion!!

I am 38 and just had a TTT (maquet) for patellofemoral arthritis.  They can also do arthrosurface or a PKR.
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 Mrs.W

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #2 on: January 14, 2013, 06:28:49 AM »
Would you mind elaborating a little on those procedures? I'm guessing my OS is reluctant to go in there a third time. But this truly is debilitating. Thanks for your reply!

Offline Adobec

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #3 on: February 08, 2013, 03:48:23 AM »
The maquet procedure is where they slice your tibia, put a wedge of bone in it to raise the tibia anteriorly.  Mine was raised a centimetre.  This supposedly takes the pressure off of the patella and /or femoral trochlea, thereby reducing pain and decreasing further damage.  The key with this procedure is that you have to find a doc who does lots of them!  My original OS and friend had never done one.  The OS who did mine is almost 70 and has done hundreds.  I am still early in the recovery, but I am hopeful that this will buy me 10 years of pain free walking, etc.

The doc said if this doesn't work he would try arthrosurface.  I don't know much about it.  Final option would be a partial knee replacement assuming the other knee compartments are ok.

I think this site has a good picture of what the maquet procedure looks like. 
Good luck!
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 Mrs.W

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #4 on: May 16, 2013, 06:08:56 AM »
ThAnks for the reply!!! I will research. Sooooo painful  :-\

Offline christine67

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #5 on: May 16, 2013, 06:03:11 PM »
Hi Mrs. W,

I am 46 yr s and have osteo-arthritis in my knees, my surgeon is going to be doing a TTT and Partial knee replacement together he is replacing just the patella-femoral joint as that's where I have the bone on bone arthritis and the TTT is because my patella sits to high in the trochlea-groove.

It is a complex operation and a long slow recovery but hopefully it will be worth it if it stops the instability in my knee as I have being suffering a lot off dislocations since my early 20s

hope this is some help to you

Chrissy 67
Dislocation in both knees in late teens
1988 realignment of R/knee
2009 Dislocations start again
Oct 2011 scope
Dec 2011 femoral de-rotation
April 2012 bone graft
Aug 2012 metal work removed and replaced with plate
Aug 2013 PFJR, tibia tuberosity transfer
April 2014 femur hardware removal.

Offline JessJess28

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #6 on: May 16, 2013, 11:40:20 PM »
I have similar issues to you and I am in my 30's as well. 6 weeks post op from a, TTT too. Hoping it helps with my pain and arthritis too. I would get a second opinion like the others said. Hope you can get some relief soon. Hang in there!
History of Dislocations
12/08 Scope
3/2013 TTO, Lateral Release, Medial Reefing, Grade III Patella lesion.
11/2013 TTO L knee, LR, Medial Reefing, R knee screw removal

Offline Mrs.W

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #7 on: June 22, 2013, 06:41:26 AM »
Thanks all! Having MRI on Tuesday, looking forward to some relief! It's unbearable!

Offline 15run

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #8 on: June 23, 2013, 03:38:30 AM »
Mrs W
You mention that the OS may not want to go in a 3rd time but I believe it comes down to the fact that the surgical options are as others have mentioned (TTO,PKR,) and they are to overcome  specific problems, and those are for the highly specialized PFJ OS.   You will want to know where in the knee the problems are.
2001 chondromalacia, xrays
synovisc, 2011 mri,

Offline Mrs.W

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #9 on: June 30, 2013, 06:24:58 AM »
Yes, you are right. I have bone on bone patellofemoral osteoarthritis. I'm bummed out. Only 37.

Offline JessJess28

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #10 on: June 30, 2013, 11:31:12 PM »
Keep us posted re: your MRI and follow up Dr appt.

I found out during my TTT that I have a Grade 3 lesion under my patella, so almost bone on bone. I am in my 30's too. I am 13 weeks post op now, still have some pain though. I'm not sure if it's from the arthritis or still just part of the healing process. I also have bone spurs too. Hope you get some answers soon! Good luck!
History of Dislocations
12/08 Scope
3/2013 TTO, Lateral Release, Medial Reefing, Grade III Patella lesion.
11/2013 TTO L knee, LR, Medial Reefing, R knee screw removal

Offline Mrs.W

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #11 on: August 30, 2013, 05:46:11 AM »
Well I just had a cortisone injection today. Dr. Days it's step one. Next we're going to try Synvisc (SP?) if that doesn't provide relief I'm going to push for a PKR. But they say I'm too young. I'm just miserable. How are you all fairing?

Offline JessJess28

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #12 on: August 30, 2013, 04:29:43 PM »
My OS suggested the Synsvic injection for me too, even after my TTO surgery. I don't think my INS covers it though.

Can you get a 2nd opinion? There could be a surgical solution other than a PKR or TKR at your age that your current Dr hasn't mentioned. It can't hurt to ask. Depending on where you live you might be able to find a reputable Ortho by searching this board. I had to go to a few Orthos until one proposed a TTO to help with my chronic knee pain and alignment issues.
History of Dislocations
12/08 Scope
3/2013 TTO, Lateral Release, Medial Reefing, Grade III Patella lesion.
11/2013 TTO L knee, LR, Medial Reefing, R knee screw removal

Offline randoknee

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #13 on: September 03, 2013, 08:25:56 AM »
Hi Mrs. W,
I can sympathize with your situation.  While I'm an old codger at 52, I too had a patella fx on my "bad" knee and now have the resultant arthritis.  My "good" knee has progressively gotten worse over the last 5 years since my original injury and I now am bone on bone in my PF compartment.  I'm scheduling a PFA for my good knee in the next couple of months to get it in the best possible shape before dealing with the "bad" one which also is bone on bone but also needs the patellar tendon shortened.  That one will be a sucky recovery.   

As a frequent consumer of knee related orthopedic services, it took me a while to figure out not all orthopedic surgeons have the skill set, interest or expertise in dealing with patella-femoral issues.   There are no OS in my area that are familiar or experienced in resurfacing options, so they say my choices are only pain or a TKR.   I will be traveling to have my PFA done by a surgeon who is very experienced in these procedures.  He did my fx hardware removal and has scoped both of my knees and knows exactly what's going on with them.  Finding a doc who is a patella-femoral specialist took me a bit of effort and a bit of luck.  When I was dealing with my delayed union of my fx patella, I got a 2nd, 3rd and 4th opinion before choosing the doc who I am now working with. 

I wish you the best in finding good pathway to relief.  Dan
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline Mrs.W

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Re: SEVERE patellofemoral arthritis. Post fracture/hardware removal
« Reply #14 on: December 28, 2013, 04:04:26 AM »
Thanks all for your replies! I've seen an orthopedic surgeon/trauma specialist, and 2 sports medicine doctors at the University of Miami hospital in Downtown Miami, their sports medicine clinic is world renowned. That being said, I had a round I cortisone injections, which did absolutely nothing and in late September I had the Synvisc, which too, did not relieve the pain. I am so very discouraged. It is compromising my fitness goals and I'm just getting fatter and eating more out of misery which only exasserbates the issue. And when it rains I just want to die.