Banner - Hide this banner





Author Topic: advice needed  (Read 1190 times)

0 Members and 1 Guest are viewing this topic.

Offline dhourigan

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 0
advice needed
« on: May 03, 2016, 02:03:37 PM »
Hi Everybody,

I'm looking for a bit of advice and have stumbled across this forum.
I have just been told today that after an MRI scan my patella cartilage has totally worn away and the bones are wearing against each other. Pain wise, it is not too bad but I suffer severe swelling and reduction in motion especially bending down. All in all I am not suffering too badly but I am worried for the near and more distant future.
I am 42 years old and a keen runner and cyclist, having represented GB last year for my age group(ameteur level), only last year. I specialise in ultra endurance and often run 40 mile plus fell runs. (never on roads though).
My GP, tells me that knee replacement is the usual course of action and my knee is akin to an old man.
The questions i have are,
Does it sound like a replacement job? or what are the options available?
Is it better to keep running and cycling until I can do no more and then get it treated? or get it operated on now?
Will I be able to recover and cycle/run after such an OP? and to the same level?
Finally, is the a difference between private and NHS, in terms of quality and available repairs?

Any help or advice is greatly appreciated as I don't know what I will do without my sports.

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 404
  • Neelie knee!
Re: advice needed
« Reply #1 on: May 03, 2016, 06:46:32 PM »
Unfortunately, if you are bone on bone, the options are rather limited especially when it comes to the patella as the shearing forces when you bend and straighten will place a lot of stress on any repair.  Also, running places great strain on the knees as you have found - you need to understand whether this is purely down to overuse but more likely there is misalignment in the patello femoral joint and this poor tracking has caused this damage, exacerbated by the stresses from running especially. If the joint is not aligned, it might be that you require an osteotomy to align the bones and get them running more smoothly as well as a replacement

You can just get the patella and groove resurfaced, called a Patello femoral joint replacement but you need an orthopaedic surgeon specialised in the patella as these are quite rarely done. Where are you in the uk?

Generally, due to the finite life of replacements, these tend to be reserved for older patients, especially on the NHS. You might find a surgeon willing to replace privately but you would expect a large bill, 10k or more plus rehab etc. Most uk surgeons operate on the NHS so personnel wise there isn't much difference, although going privately enables continuity of care and you can see your chosen surgeon when and where you like, anywhere in the country (with a GP referral), you can select surgery dates etc, in short you have much more control but the bills can add up rapidly. 

The best way might be to do your research, see a patella specialist privately and then decide how to proceed. Some procedures are only available privately, generally the more experimental repair procedures, certain types of joint replacement etc and your age might also impact your access to replacement on the NHS. Your GP might be able to advise on who to see locally.

However, you would most likely be strongly discouraged from running especially as the strains placed would shorten the life of the replacement and are generally not good for knees. Cycling (with modifications to gearing and the terrain for your ride, not standing on the pedals, ensuring spot on cleat placement and bike fit etc), spin classes etc, or swimming are usually possible after an extensive period of rehab. You'd probably be advised to modify your activity prior to surgery too. I personally wouldn't carry on as before doing further damage potentially. Get advice from a surgeon and find yourself a good sports physio with a knee specialism

This is quite a detailed guide from the Royal national orthopaedic hospital north of London. You'll see info towards the end about potential activities, long distance running, impact etc not permitted generally

https://www.rnoh.nhs.uk/sites/default/files/downloads/updated_physiotherapy_rehabilitation_guidelines_-_tkr_ukr_pfjr.pdf

There is good info here in the patella and arthritis primers, look at the relevant parts. There are also courses and videos in the learning hub

http://www.kneeguru.co.uk/KNEEnotes/primers

Good luck :)
« Last Edit: May 03, 2016, 07:02:59 PM by Vickster »
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 dhourigan

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 0
Re: advice needed
« Reply #2 on: May 03, 2016, 08:52:32 PM »
Thanks for the reply Vickster, although not what I wanted to hear it it was I suspected.

I am based near Manchester and have been told Professor Phil Turner (Cheadle, Manchester) is one of the best around? Can you suggest anyone else?

I am going to follow your advice and pay for a private consultation and then assess my options from there on in.
In your opinion, would you get the repair done immediatley or wait until it starts to cause more pain? as at present I am seldom in much pain, more just swelling and the annoyance of limited range of motion which generally improves as I excercise for longer and the joint 'warms' up.

Thanks

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 404
  • Neelie knee!
Re: advice needed
« Reply #3 on: May 03, 2016, 09:04:44 PM »
If your guy has been recommended, check his CV and areas of expertise. Even knee surgeons have special areas and interests. He does PFRs so looks a decent place to start. Good info, also says no major running and a limited life span for the prosthetic http://www.manchesterkneesurgeon.co.uk/page.php?id=66

 The Oxford group are expert in single compartment replacements, and a Prof Donnell in Norwich is a patella expert.

Personally, I would wait before major surgery, especially a replacement which is a last resort one way journey, but I would modify activity and work with a sports physio to determine appropriate activity :). If pain and function are livable, manage with ice, rest, avoiding activity that causes issues, even some sort of appropriate brace or support, a physio is best for such things...sooner or later surgeons like to cut, but they can also offer medication, injections etc

There is likely no simple repair unfortunately for the extent of arctic ulnar cartilage damage you have. Small areas can be patched up but not if the damage is diffuse and through to the bone. I'm your age, have quite tatty knees but I certainly wouldn't be considering a replacement if able to function and in minimal pain. Hyaluronic acid injections can be quite good for inflammation due to arthritis, ask the surgeon. They work for some, not others, but  for a few hundred pounds could be worth a try. I have them and get decent relief for a couple of years.
« Last Edit: May 03, 2016, 09:10:46 PM by Vickster »
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 dhourigan

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 0
Re: advice needed
« Reply #4 on: May 03, 2016, 09:24:37 PM »
Thanks, once again Vickster, very valuable advice.
The surgeon, that was recommended to me apparently  looks after Man utd's players Knees, http://www.manchesterkneesurgeon.co.uk/ - seems he does specialise in PFR so I am going to take your advice and book a consultation tomorrow.
My fear was surgery being a point of no return and hopefully it will be something that I can avoid for a few years more, fingers crossed.

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 404
  • Neelie knee!
Re: advice needed
« Reply #5 on: May 03, 2016, 09:28:13 PM »
It's more important that he has expertise in your specific pathology than fixing footballers ACLs and meniscus tears. I certainly wouldn't take Man U as a recommendation ;)  :P
Good luck. I would see a replacement as the point of no return so best avoided for as long as possible :)
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 IMF73

  • MINIgeek (20-50 posts)
  • **
  • Posts: 49
  • Liked: 2
Re: advice needed
« Reply #6 on: May 04, 2016, 02:10:41 PM »
You sound very similar to me in terms of age, lifestyle and injury. Is it totally worn or a percentage of it worn away?
I was told I was too young for a replacement & I had surgery involving stem cells, although mine wasn't the whole patella area, it was part of it. Mine was 6 months ago and Im recovering well.

Im still not running but if it helps I do plan to get back to running. My knee may have other opinions but I will see. I am confident I will run again.
Be interested in they suggest any other form of surgery/repair.

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 404
  • Neelie knee!
Re: advice needed
« Reply #7 on: May 04, 2016, 02:54:07 PM »
If he's bone on bone, presumably the trochlea is also grade 4, kissing defects make cartilage repairs very difficult, especially if the alignment isn't spot on and the damage extensive. I'm not sure a graft type repair would be feasible, but ask the surgeon what options exist.

 It wasn't feasible for me for a femoral wb defect as I'm a little knock kneed
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 IMF73

  • MINIgeek (20-50 posts)
  • **
  • Posts: 49
  • Liked: 2
Re: advice needed
« Reply #8 on: May 04, 2016, 02:59:46 PM »
Agree. Although I had 2 defects and was grade 4. Each injury is so different.
I think it may depend if it's the whole area of the patella or just a small percentage of it.

I can only go on experience and I had 2 grade 4 defects and touch wood so far so good.
Good luck with it whatever is suggested.

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 404
  • Neelie knee!
Re: advice needed
« Reply #9 on: May 04, 2016, 03:07:32 PM »
How big were the grade 4 areas?

Also, the OP is in Manchester, weren't you treated in Kent? How far did you have to travel? I had to go about 40 miles for one arthroscopy which I could rehab locally. I can't imagine travelling 200 miles but others might
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 IMF73

  • MINIgeek (20-50 posts)
  • **
  • Posts: 49
  • Liked: 2
Re: advice needed
« Reply #10 on: May 04, 2016, 04:50:22 PM »
Mine were 1cmx1cm & 2cm x 1.5cm.
Doesn't seem massive to me but big enough. Or is that big? I don't really know and have nothing to compare it to.
A different story if this guy has the whole area gone. I was given the impression the whole area had gone in my knee after the MRI but after the surgery I was then told the sizes.
Not sure if they just didn't give me that detail or whether they cant tell the exact size until they go in.   I doubt it, I'm sure the MRI can give exact sizes but I was given the impression all my articular had worn away after they saw the MRI. Although this could also have been me misunderstanding


My surgery was very local to me, I was lucky the surgeon was local. Although would I travel? Yes I would to see the right surgeon. I didn't realise that some specialise in certain areas, before all this I suppose I assumed a knee surgeon was a knee surgeon but in hindsight now I would travel to get fixed.

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 404
  • Neelie knee!
Re: advice needed
« Reply #11 on: May 04, 2016, 05:45:39 PM »
Fairly big i think if you consider the size of the patella

Did you have the treatment privately? If so it would be useful to have a ballpark idea of the cost, whether self pay or insurance funded
« Last Edit: May 04, 2016, 05:48:43 PM by Vickster »
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 dhourigan

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 0
Re: advice needed
« Reply #12 on: May 10, 2016, 08:41:13 PM »
You sound very similar to me in terms of age, lifestyle and injury. Is it totally worn or a percentage of it worn away?
I was told I was too young for a replacement & I had surgery involving stem cells, although mine wasn't the whole patella area, it was part of it. Mine was 6 months ago and Im recovering well.

Im still not running but if it helps I do plan to get back to running. My knee may have other opinions but I will see. I am confident I will run again.
Be interested in they suggest any other form of surgery/repair.

Thanks for the reply - I have been told it is totally worn (what my GP said) but am due another appointment at the MSK centre this week, where I should find out more.
The funny thing is I can still run or cycle and be competitive although I suffer for a few days afterwards with swelling and moderate pain. I have noticed the crepitus getting much worse and am aware that it needs sorting sooner rather than later.
Glad to hear you are recovering well and hope you're running soon.

Offline IMF73

  • MINIgeek (20-50 posts)
  • **
  • Posts: 49
  • Liked: 2
Re: advice needed
« Reply #13 on: May 10, 2016, 11:21:28 PM »
You sound very similar to me in terms of age, lifestyle and injury. Is it totally worn or a percentage of it worn away?
I was told I was too young for a replacement & I had surgery involving stem cells, although mine wasn't the whole patella area, it was part of it. Mine was 6 months ago and Im recovering well.

Im still not running but if it helps I do plan to get back to running. My knee may have other opinions but I will see. I am confident I will run again.
Be interested in they suggest any other form of surgery/repair.

Thanks for the reply - I have been told it is totally worn (what my GP said) but am due another appointment at the MSK centre this week, where I should find out more.
The funny thing is I can still run or cycle and be competitive although I suffer for a few days afterwards with swelling and moderate pain. I have noticed the crepitus getting much worse and am aware that it needs sorting sooner rather than later.
Glad to hear you are recovering well and hope you're running soon.
Thanks. I am cycling but don't plan to start running for a few more months yet. I will have t se if the knee can handle it....I hope so!!
I hope yours isn't too bad & you get it sorted. Keep us posted.

Offline dhourigan

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 0
Re: advice needed
« Reply #14 on: May 15, 2016, 08:47:35 AM »
I had my consultation with the MSK specialist on Friday and he went into my injury in a little more detail and viewed the MRI scans.
The articular has completely worn away on the lateral side but is still present medially. this is causing my knee cap to tilt outwards. Also, a very small damaged area on the meniscus.
He tells me normally with the damage evident from looking at the MRI alone he would have expected to see someone in severe pain and struggling to walk but thinks a combination of muscle strength and high pain threshold from my sports is keeping it at bay. He didn't even tell me to curtail the sports?
All in all, he admitted that my case is not something he can deal with and has referred me to a patella femoral sports specialist, which happened to be one of the surgeons I was considering seeing privately. (Professor Turner).  Hopefully I will get an appointment soon and be able to progress in getting the damage repaired.