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Author Topic: Way Forward After Multiple Surgeries  (Read 1363 times)

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Offline Sue G

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Way Forward After Multiple Surgeries
« on: January 12, 2015, 11:00:13 AM »
Hi, I suffer from patella alta with mal-tracking and recurrent knee cap dislocations in both knees and have had 5 arthoroscopies with debribement and 1 arthoroscopy with debribement and a lateral release in the last 7 years (every time both knees were operated on at the same time). My last surgery (with the lateral release) was done exactly two years ago. There are barely any cartelidge left under the knee caps, so it is basically bone on bone now. I can barely walk and cannot climb stairs or do any type of excersize without extreme discomfort and pain - no amount of physio or medications makes any difference. What are my options?

Offline MDAL

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Re: Way Forward After Multiple Surgeries
« Reply #1 on: January 12, 2015, 03:56:29 PM »
Sue:

What has your doctor suggested? Have you reached the age for a knee replacement? Some doctors may pose obstacles to a replacement at younger age others not so much...

If you are totally bone on bone, the options are total knee replacement or a patello-femural replacement (metal plates) between bones.

There is some effort being done in attempting to recover even extreme cases (Dr. Saw Yong) in Malasya for example is doing some work which includes recovering large extensions bone on bone including patella.

But this is more in the experimental and very expensive field... out there in practice the options are a replacement, but age is an important factor in that decision because the plates don't last forever and revisions (replacement of the replacement) are more complicated...

Offline vickster

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Re: Way Forward After Multiple Surgeries
« Reply #2 on: January 12, 2015, 04:09:01 PM »
To add, you'd probably be best trying to seek out an orthopaedic specialist with an interest and lots of experience in dealing with patella issues (this will depend on where you are in the world and your ease of access to healthcare).  Realigning bones and fixing ligaments may help, injections may bring some relief but probably temporary.  As MDAL, age may well play a big role in what can be done. Before the cartilage can be fixed, the issues (i.e. tracking and dislocations) need to be rectified or any fix will just wear away or fail You need to have a frank discussion and understand your options especially if pain medication isn't helping 

In the information hub, there are primers dedicated to the patella

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 Sue G

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Re: Way Forward After Multiple Surgeries
« Reply #3 on: January 13, 2015, 05:49:54 AM »
Good Morning MDAL & Vickster;

Thank you for your quick replies.

I am 37 years old - my specialist is against a total knee replacement - he says i am too young, but, with the last operation two years ago he did indicate that we are definately heading that way. I am seeing him on the 30th again, but want to go in and have a frank discussion on my options, as I cannot live with the pain and discomfort any longer.

I am in South Africa, and have excellent private health care, so that is not a problem - I am also just wondering if i must go for a second opinion, but my specialist is absolutely fantastic - he has been with me on my journey and i know he's got my best interest at heart.


Offline MDAL

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Re: Way Forward After Multiple Surgeries
« Reply #4 on: January 13, 2015, 05:02:48 PM »
Yes, at 37 I suppose the majority of doctors will try to delay it until as late as possible (for good reasons)...

Other options you have are microfracture (but very few will do it on large extensions and especially in the patella). You might find interest in this thread and the video link in the last post:
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=64362.0

ACIs  or MACIs (check in the sub-forums: http://www.kneeguru.co.uk/KNEEtalk/index.php?board=51.0), but it is very dependent on size of defect... you seem to mention that its all gone... this is also not a common procedure, very hard to find doctors who do them... not sure in SA.

Aside this only management options HA (oiling the joint) and PRP for anti-inflammatory effects. But if you are totally bone on bone PRP might not work so well for you... and HA could have very limited effects.

Offline Sue G

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Re: Way Forward After Multiple Surgeries
« Reply #5 on: January 18, 2015, 09:17:46 AM »
Hallo MDAL;

Thank you so much for the additional information.

I agree that i may be too young for a total knee replacement, but something needs to be done urgently - there is not a single day that goes by that i am not in pain and cannot walk properly.

I have done a LOT of research during the past few days and I think I'll talk to my surgeon about the Patellafemoral Replacement Arthoroscopy - it seems as if the success rate with this surgery is quite good and it should give me pain free mobility - now the only question remaining is if i should do both knees at the same time, or just one???

Offline MDAL

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Re: Way Forward After Multiple Surgeries
« Reply #6 on: January 18, 2015, 09:23:51 PM »
I understand, if you feel like you can't go any more... but you will need to convince a doctor to do it... you might need to knock on a lot of doors before one accepts it... they don't like doing it in young age.

Also note that for a total knee replacement everyone does it, for a PF replacement only, you might need a more specialized surgeon.


Offline traumaqueen63

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Re: Way Forward After Multiple Surgeries
« Reply #7 on: January 19, 2015, 04:02:09 AM »
hi there

I had a PF replacement at the age of 46 in England and had to fight to get it.
Unfortunately it hasnt worked I am now 51 and had one knee done twice and one once, I am in severe chronic pain everyday, on loads of opiates for any type of releif and have been told am too young for TKR so i dont know what Im to do.

please think hard before you commit

regards

Offline Sue G

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Re: Way Forward After Multiple Surgeries
« Reply #8 on: January 21, 2015, 06:44:40 AM »
Good Morning MDAL;

Thank you for your advice - I will have the discussion with my surgeon on the 30th and we'll see what we can do.

Good Morning Traumaqueen63;

I am so sorry to hear of the difficulty you are experiencing - I know in how much pain I am in every day, and to hear that you have had the op and it was not a success - I can't even imagine what your pain level must be like.

My surgeon also says I am to young for a TKR - but I am desperate - I will take your advise also in consideration when I speak with him.

Good luck, and I hope you can be helped in one way or another.

Kind Regards
Sue

Offline Sue G

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Re: Way Forward After Multiple Surgeries
« Reply #9 on: February 24, 2015, 10:12:40 AM »
Hi, I am seeing my surgeon on Monday, 02 March 2015 to decide on when to do a total knee replacement surgery and which knee to do first, or decide if we are going to do both knees at the same time (I doubt this, not sure how I will cope with both knees out of action). I am scared s*@tless, but have no other alternative - we decided against the PF replacement, as the arthiritis are too far progressed for the op to be a success - so, two tkr are on the cards.