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Author Topic: Didn't get surgery for shattered patella - wondering if I made a mistake?  (Read 239 times)

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Offline nosher1

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Hello,
I suffered a moderately displaced comminuted fracture of my right patella in a car accident - a head on collision.  I got the opinions of 3 different orthopedic surgeons that do patella surgery.  I was able to bend and extend my knee and also lift my leg while straight, so my patella was still fully functional after the fracture.  Two of the surgeons said that the pieces of bone were close together enough that I should not get the ORIF surgery because my patella was still functioning fine and there is really no good evidence that having the surgery done would significantly reduce my odds of getting arthritis down the road.  The third surgeon said that I should definitely get the ORIF surgery to reduce the odds of getting arthritis in the future.  He said the smoother the back of my patella is, the better, in regards to avoiding arthritis.  The other two surgeons did not agree that it would make a huge difference and they both felt that the risks of surgery did not necessarily outweigh the benefits, and they were at the two top hospitals in my area, so I opted not to get the surgery.  I had very lengthy discussions with one of the surgeons (who has a great reputation in my area), and he said my case was kind of a borderline case because I had some displacement, but he felt very strongly that the most important factor in determining if I will develop arthritis from the injury is the amount of cartilage damage caused by the actual injury.  If the cartilage damage is extensive, ORIF surgery is not going to change that.  And he said there is a widely believed myth that ORIF surgery provides big benefits in regards to preventing arthritis, but there is really no way of knowing if the benefits of ORIF surgery for the purpose of helping to prevent arthritis from this particular injury outweigh the risks of the surgery (risks associated with general anesthesia, risk of infection, and other potential complications).  And he said he's seen plenty of patients who have successful ORIF surgery who go on to get arthritis.  He said if it was his knee, he would not do the surgery because the upside is probably too small to outweigh the risks.
The one surgeon who was recommending surgery was in his 50s while the two surgeons who advised against surgery are in their 30s, so I think this may be a case of old-school versus new-school thinking.  Old-school thinking is that you want to fix any joint and make it as much like the original joint as possible in order to prevent arthritis.  New-school thinking is that joint reduction is not a magic bullet and the cartilage damage caused by the injury is the main factor that determines if you will get arthritis in the future, so the risks of surgery don't always outweigh the benefits in regards to arthritis prevention.
I am now 12 weeks post-fracture.  For the first six weeks, I was allowed to start physical therapy and bend the knee up to 90 degrees, and I had to wear an immobilizer only while walking.  For the next 6 weeks, the only real restriction I had was no resisted extension, and no running. 
Overall, my knee feels much better, and I typically only have had pain while sitting/driving.  There has been gradual improvement.  At the six week mark, when I started driving again, I could only sit for about 10 minutes before the pain would become too intense and I would have to stop and get out and straighten my leg for a few minutes and then resume driving.  Now, I can drive 30 plus minutues without significant pain, so I'm definitely improving. 
But one thing I noticed is that right around the 12 week post-fracture mark (starting a few days ago) I started getting random shooting pains or burning in my right knee while walking.  It doesn't happen often, and 99% of the time, my knee feels OK - it still feels tight all day, almost like there is elastic resistance, but it usually doesn't hurt unless I keep it bent for too long.
From week 6 (when I stopped wearing the immobilizer while walking) to week 12, I really didn't have any pain while walking unless I stumbled or stepped awkwardly. But the fact that I have these new, occasional shooting or burning pains while just walking normally is making me nervous.   Is it way too early for these pains to be related to arthritis or bone-on-cartilage contact?  Is it just a normal part of the healing process?
I have attached a picture of my x-ray taken 5 days after the accident. 
Please share your thoughts.  Did I make a mistake not having surgery?  If so, what do I do now?  Or is it still too early to tell if I made a mistake?
Thank you!
« Last Edit: March 12, 2020, 06:12:32 AM by nosher1 »

Offline lostpirate

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Yours is an interesting case. I don't think I have ever heard another one like it. Generally speaking if you can do a straight leg lift then you should not need to have surgery. At least that is what it was when I broke mine...many years ago. The tightness you are feeling is normal. Its been almost 11 years for me and my knee still feels a bit tight. You get use to it to the point you don't really realize it anymore. They call this your "new normal". I have not had any pain in my knee since. There could be a variety of reasons for your pain. Could be the way it healed that it left a ragged edge or bone spur that is causing it. My advice would be to go back to one of the OS's you talked to and get their opinion. If besides that pain you can pretty much do what ever you want to on the knee you probably did not make the wrong decision. I have a slight bone spur on my knee because of the way it healed. My OS said not to worry about it, if it ever did cause me pain then he could go in file it down/smooth it out. Maybe it's as simple as that for you....Good Luck!
5/2/09..Broken right patella
5/4/09..Surgery. 2 pins and wire
6/5/09..Began PT (60 degrees ROM)
6/12/09..Began walking out of immobilizer
6/29/09..2 month check up (130 degrees ROM)
7/12/09..Full ROM
7/22/09..Shifting pin
8/14/09..pin removed
11/10/09..All hardware removed

Offline nosher1

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What do you think in regards to the increased odds of developing arthritis? My surgeon said he could not predict the odds but a wild guess was that I had a 50/50 chance of developing arthritis from the injury.

Offline lostpirate

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I have been told that chances of developing arthritis is greater with this type of injury. So, yes, what you have been told is probably accurate. I am 11 years out since my fracture and have shown no signs of it. Keeping my fingers crossed!

5/2/09..Broken right patella
5/4/09..Surgery. 2 pins and wire
6/5/09..Began PT (60 degrees ROM)
6/12/09..Began walking out of immobilizer
6/29/09..2 month check up (130 degrees ROM)
7/12/09..Full ROM
7/22/09..Shifting pin
8/14/09..pin removed
11/10/09..All hardware removed















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