Banner - Hide this banner





Author Topic: total patellectomy  (Read 2670 times)

0 Members and 1 Guest are viewing this topic.

Offline shelly86

  • Regular Poster
  • ***
  • Posts: 101
  • Liked: 0
total patellectomy
« on: November 14, 2013, 03:36:19 PM »
Just spoke to my surgeon and after years of dislocations and operations he has suggested I get a total patellectomy. He has advised me this will make my leg weaker than my good knee but the way I am at the moment I really need this. Has anyone had this done and if so could you give me some information about it. I have spoke in great lengths with the surgeon but it's always nice to hear from someone who has been through it.

Thanks in advance

Offline allyd

  • SuperKNEEgeek
  • *****
  • Posts: 678
  • Liked: 34
Re: total patellectomy
« Reply #1 on: November 14, 2013, 07:32:36 PM »
I don't know your full history, nor the full extent of why this is being proposed. But overall. A patellectomy is an outdated solution for dislocations. Have you considered a second opinion before going ahead with this? Since its permanent and will leave its own complications I'd want to be 100% certain this was my last/only option available.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline shelly86

  • Regular Poster
  • ***
  • Posts: 101
  • Liked: 0
Re: total patellectomy
« Reply #2 on: November 15, 2013, 09:20:22 AM »
Hi, thanks for ur reply. I have had dislocations of both knees since I was 14, I'm now 27. I have had lateral release done in both knees. This worked for my left knee (touch wood) but not for my right knee so had a patella realignment done.2 and a half years ago. It has since starred dislocating again and after loads of scans and x rays the surgeon has advised me this is the last option. I have seen 3 different orthopaedic doctors who have looked at my scans and told me my whole leg has alignment issues therefore dislocations will always be a problem. I have 100% faith in my surgeon as he has been with me since I was 14. This problem has made my life hell and hopefully this helps me!!

Thank you for your reply

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 405
  • Neelie knee!
Re: total patellectomy
« Reply #3 on: November 15, 2013, 10:52:27 AM »
Have any of the surgeons considered realigning the bones or referring you to a specialist in this?  Removing the patella does seem quite drastic and irreversible.

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 shelly86

  • Regular Poster
  • ***
  • Posts: 101
  • Liked: 0
Re: total patellectomy
« Reply #4 on: November 15, 2013, 11:42:18 AM »
My surgeon specialises in this sort of surgery, and has done everything possible. It is such a major surgery I know but I am only 27 and have yet to enjoy my life as.my knee problems have ground everything to a halt.

I know it's irreversible and the surgeon told me he would not even suggest it at such a young age if there was anything more he could do.

I have got my pre assessment in 3-4 weeks , but could anyone tell me the recovery period etc or is it different with each individual.

Thank you.

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 405
  • Neelie knee!
Re: total patellectomy
« Reply #5 on: November 15, 2013, 11:50:34 AM »
If you search there are a few on here who have had a patellectomy but mostly in the distant past and have come asking for help with issues.  In my 4 years of using this forum, I can't recall anyone having it done around the time of posting, or going to have it done. 

There are a number who have had their leg(s) realigned through de-rotation of the long bones however, which is what might be an alternative, although presumably this has all been discussed.  Also, no picnic recovery wise though.

All the best :)
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 allyd

  • SuperKNEEgeek
  • *****
  • Posts: 678
  • Liked: 34
Re: total patellectomy
« Reply #6 on: November 15, 2013, 05:14:38 PM »
What type of scan/measurements have you had done on your legs/knees? What specifically have the doctors stated was alligned incorrectly?  There are a lot of knowledgeable people here that have dealt w patella dislocations similar to you. And have found solutions. So don't be afraid to share and ask for ideas on options/questions to ask your doctor. Like vickster says... you may want to do a little research on de-rotation procedures and see if it would fit your symptoms/situation. There are other procedures that may help as well. Never hurts to ask your surgeon the questions.

I will simlly say it again. This is an outdated "fix" for patella dislocations. I'm very rarely one to suggest doubt in a chosen surgeon as he/she has the most knowledge regarding your situation. But given the procedure suggested I would personally want to make sure another surgeon who understands/specializes with patellafemoral problems agreed with the proposed plan.

As vickster notes there have been a few posters who have had patellectomys come to the board. So you could tyoe into the search box. I only caution you to do a lot of research before this on all options as any story ive read regarding a patellectomy has not been "a success" - basically, you'll solve the dislocations,  but create new problems. Just make sure you know your options and make an informed decision.

Check out the patellafemoral section of this board. You may find some helpful ideas/suggestions.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline geococcyx

  • MINIgeek (20-50 posts)
  • **
  • Posts: 44
  • Liked: 1
Re: total patellectomy
« Reply #7 on: November 15, 2013, 09:08:32 PM »
Someone recently posted a link to this site (don't remember who or where): http://www.patellamd.com/ . This dr says that lateral release is not a good idea unless you repair it afterwards.
Quote:
"My experience clearly shows that stability of the the lateral patellar soft tissues (lateral retinaculum) is a key to a successful outcome in treating patellofemoral problems. Unfortunately, lateral release, cutting the lateral retinacululm to allow the patella to center in the femur, is almost universal treatment.  The soft tissue defect created by the lateral release is not repaired but left open.  This lengthens the lateral side and destabilizes the patella.  This can and should be repaired to restore lateral side stability in every case.  Without repair, it is very difficult to obtain excellent stability.  There are even cases where the lateral retinaculum is naturally loose without lateral release.  In these instances, tightening of the lateral retinaculum will help restore patellar stability. "

Maybe you need such a repair. At least ask about it before you lose your kneecap for good. Don't know if you're anywhere near this guy though, or if not, who else might do it, maybe someone else here would know.

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 405
  • Neelie knee!
Re: total patellectomy
« Reply #8 on: November 15, 2013, 09:21:45 PM »
The doctor is in Michigan in the US.  The poster is in Scotland
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 IHMK

  • Forum Faithful
  • ****
  • *
  • Posts: 249
  • Liked: 26
    • I Hurt My Knee
Re: total patellectomy
« Reply #9 on: November 15, 2013, 10:22:37 PM »
allyd posted that link on Sandra1981's post here in the General knee questions forum :)

I'm guessing geococcyx (aka roadrunner? A birdwatcher on the boards!!) was suggesting that if what the Michigan specialist says is true, this may explain why shelly86's previous lateral release operations were not successful (i.e., if the lateral retinaculum was not repaired after the release).
My knee story: http://www.ihurtmyknee.org

28 March 2013: tore right ACL (also meniscus tear, MCL tear ["Unhappy Triad"!!], tibial plateau fracture & condylar bruise)
28 June 2013: surgery to reconstruct ACL (allograft)

Offline geococcyx

  • MINIgeek (20-50 posts)
  • **
  • Posts: 44
  • Liked: 1
Re: total patellectomy
« Reply #10 on: November 15, 2013, 11:32:40 PM »
IHMK: Thanks for reminding me, I just bookmarked the page and then forgot where it came from... And yes, you summed up quite well what I was trying to say. Also, it seems the repair can be done later, after an LR without one has failed.
Anyway I've never seen this doc myself, or had any lateral releases, so I can't speak from experience, but at least allyd seems to have faith in him and his ideas. And from what I've been reading here LRs seem to fail a lot. Could be he has a point. At least If it were my knee I'd have looked into any alternatives before having my kneecap taken out....
I missed the Scotland part, is it in another thread? Anyway, if shelly86 is interested there's an email address for the doc at the site, won't get any medical advice but maybe a recommendation for someone closer?

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 405
  • Neelie knee!
Re: total patellectomy
« Reply #11 on: November 16, 2013, 12:09:06 AM »
Might have been in another post.  There are a couple of patella specialists in the uk who come to mind, but they are pretty far from Scotland, many hundreds of miles :)

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 allyd

  • SuperKNEEgeek
  • *****
  • Posts: 678
  • Liked: 34
Re: total patellectomy
« Reply #12 on: November 16, 2013, 01:13:50 AM »
I did post that link - but was mostly to point sandra1981 in the direction of a local doctor. (local as in same city) I thought the website would help her learn a little about her problems, as well as allow her to form her own opinion of the doctor as I really know very little about him, but have seen his name pop up on here a few times.

Getting back to this thread. The important thing to note is that not all patella instability is created equal. It sounds like shelly86 has been around the block a few times with surgeries and has had more work done than just the lateral release. Even though isolated LR's are no longer indicated for instability, It sounds like her problems may lay in her alignment more so than the lateral release(s). She points out specialists have said her WHOLE LEG has alignment issues. Which may (and I'm absolutely making some assumptions) mean she is one of the lucky few with some extent of miserable mal-alignment.

She states her current doc specializes in pf problems and she has complete trust there. I'm not going to question that. I think the advice here is to seek a second knowledgeable opinion because of how permanent the patellectomy is. Shelly86 - if it were me, I'd go into a second opinion appointment with everything your doctor has said and directly ask "do you agree this is my last/only option" I would just want the piece of mind that another doctor agrees.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline shelly86

  • Regular Poster
  • ***
  • Posts: 101
  • Liked: 0
Re: total patellectomy
« Reply #13 on: November 16, 2013, 09:22:14 AM »
Hi, thank you for all your replies. Its not just lr surgery I have had done, the last of my operations was 2 years ago where he done a patella realignment. This was unsuccessful as my patella has started to dislocate again. The alignment issues are in my whole leg. This is a second opinion, the first surgeon I seen suggested this but I wasn't sure and it wasn't my usual surgeon as he was on holiday. I waited until his return and asked his opinion and he told me this was my only option as my alignment issues were always gonna make it dislocate.

Thank you

Offline shelly86

  • Regular Poster
  • ***
  • Posts: 101
  • Liked: 0
Re: total patellectomy
« Reply #14 on: December 27, 2013, 01:58:50 PM »
Hi, just an update on my situation. After speaking to my family and looking at the answers on here I spoke to the hospital and they arranged for me to have a second opinion to see if they agreed that total patellectomy was my last option/resort.

Have had that appointment and he done x-rays, looked at all of my surgeries and how easily my patella still dislocates and advises me this is my last option due to the mis alignment in my whole leg. He told me my patella will continue to dislocate.

So I have had my pre assessment and my operation will be done before the 6th of February. Both doctors have spoke in great detail about what will happen before during and after the operation but would like to hear from people who have actually been through it

Thanks in advance for your replies