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Author Topic: ablation or fat pad removal for fat pad impingement pain?  (Read 2184 times)

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Offline lucykneepaingoaway

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hi
please can someone shed some light.
I'm 38, female and have ehlers danlos type 3 hypermobility.
i have been on crutches for 1.5 years approx after a knee dislocation, where my knee has just not got better.
physios think it is fat pad impingement problem. I have been doing exercises after exercises & its really doing my head in that still at each physio session- when i extend my leg, i get a stabbing pain which makes me shout out.
I am overweight and will be having a bariatric surgery to help with weight loss due to meds i take causing complications.
however, even when i lost a stone last year, this didn't do anyyhing to eliminate the pain.
My physio says fat pad surgery isn't that successful &
injection shots & alcohol ablation might work. has anyone had this?
Are you sedated for it? as i don't think i could stand being awake for it.
I have been feeling so depressed about my knee pain, that I even asked about
leg amputation!
I'm so fed up as there doesn't appear to be any solution. I have been in pain for long enough & its slowly driving me crackers as it hAs affected so many things in my llife.
please could someone help?
many thanks

Offline Geronimo

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #1 on: June 30, 2017, 01:11:18 AM »
i totally understand your  pain.  :(

PT didn't help me, first surgery doesn't seem to help too (yet? :o). I would look for the best surgeon you can afford and let him give it a shot.

Offline Aly0108

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #2 on: June 30, 2017, 03:50:17 AM »
hi
please can someone shed some light.
I'm 38, female and have ehlers danlos type 3 hypermobility.
i have been on crutches for 1.5 years approx after a knee dislocation, where my knee has just not got better.
physios think it is fat pad impingement problem. I have been doing exercises after exercises & its really doing my head in that still at each physio session- when i extend my leg, i get a stabbing pain which makes me shout out.
I am overweight and will be having a bariatric surgery to help with weight loss due to meds i take causing complications.
however, even when i lost a stone last year, this didn't do anyyhing to eliminate the pain.
My physio says fat pad surgery isn't that successful &
injection shots & alcohol ablation might work. has anyone had this?
Are you sedated for it? as i don't think i could stand being awake for it.
I have been feeling so depressed about my knee pain, that I even asked about
leg amputation!
I'm so fed up as there doesn't appear to be any solution. I have been in pain for long enough & its slowly driving me crackers as it hAs affected so many things in my llife.
please could someone help?
many thanks

Hello,

Can you say about alcohol ablation? where do you find that?
I am  also the same age and have fat pad issues, very painful for me. please no surgery for fat pad, this is not a good solution.

 

Offline Brandon123

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #3 on: June 30, 2017, 10:20:44 AM »
Disabling ongoing knee problems can be depressing indeed :-\ However, in this case, have you tried any kind of taping of the patella (e.g McConnell taping)? I have read that it can help with fat pad impingement...It might be worth checking out, and finding a PT who can help you try it, if not considered yet.

https://www.youtube.com/watch?v=MzwBWdXNXx8

 
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline lucykneepaingoaway

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #4 on: June 30, 2017, 12:55:45 PM »
hi all

i haven't tried the taping- i might ask my Physio.
The orthopaedic surgeon I saw trivialised my problems & pain & said it was a weight load problem & it would be sorted in 4 months. he blamed everything on my weight pretty much! This totally depressed me as i take appetite stimulating drugs- like anti depressants which cause weight gain. Being so immobile, its hard to do any exercise. Most i can manage is to swim.

The alcholol ablation/ nerve block thing- link is here: https://qpain.com.au/wp-content/uploads/Genicular-Nerve-Procedures.pdf

thanks for all your help & replies.

I feel like i'm going in circles.

Offline Vickster

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #5 on: June 30, 2017, 01:12:06 PM »
Have you been seen by a specialist in patella issues? Might be worth seeking one out, even privately

Where are you based (assuming UK from. The terms you've used :))

I've had quite a lot of  the fatpad removed from my right knee and it did the trick alongside physio etc
« Last Edit: June 30, 2017, 01:17:12 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 lucykneepaingoaway

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #6 on: June 30, 2017, 01:56:10 PM »
i haven't just an orthopaedic.
The physio is head physio & deals with lots of knee pain.

thats great it helped you Vicky.
xxx

Offline Vickster

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #7 on: June 30, 2017, 03:28:47 PM »
Maybe that's what you need to do next, orthopaedic surgeons all have sub specialities, even if they specialise in knees

Where do you live? There are a few patella specs in the UK (are you in the UK?)
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 Aly0108

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #8 on: June 30, 2017, 07:43:10 PM »
hi all

i haven't tried the taping- i might ask my Physio.
The orthopaedic surgeon I saw trivialised my problems & pain & said it was a weight load problem & it would be sorted in 4 months. he blamed everything on my weight pretty much! This totally depressed me as i take appetite stimulating drugs- like anti depressants which cause weight gain. Being so immobile, its hard to do any exercise. Most i can manage is to swim.

The alcholol ablation/ nerve block thing- link is here: https://qpain.com.au/wp-content/uploads/Genicular-Nerve-Procedures.pdf

thanks for all your help & replies.

I feel like i'm going in circles.

I didn't find about alcohol ablation, only steroids injection. Alcohol injections that is ethanol injection not steroids.
I am looking also for ethanol injections.
You can read here:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=14629.0

 

Offline Clarkey

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #9 on: June 30, 2017, 09:56:30 PM »
Hi Lucy,

Sorry to hear that you are struggling with fat pad problems with no long term solution to try an resolve or ease the pain and discomfort. I am the same age as you, I will be 39 in December and started having right knee problems in 2003. My 1st surgery was in November 2009 with signs of fat pad impingement, tried tried all the none invasive treatment methods of PT, tapping, and a cortisone injection into the fat pad that was surrounded by fluid. In the end I opted for a diagnostic arthroscopy in the hope something else would show up, I had medial plica excision and fat pad trimming that caused excessive scar tissue build up with scope #2 in July 2014 of anterior interval release surgery to remove the scar tissue that had built around the patella tendon.

I do not want to make you feel even worse after what I have been through just pre-warning you that fat pad impingement surgery can lead to excessive scarring after surgery that is extremely difficult to get right again. It is like a vicious circle, only a few OS's Worldwide know how to deal with AIR surgery with the correct aftercare post-op.

Injection shots & alcohol ablation might work. has anyone had this?

Depending where you live and do know that the NHS does not provide alcohol ablation injections and would have to pay for it privately. I know it more popular in the States, not sure if the UK private health sector provide alcohol ablation injections? Vicky may know if it is available widely in the UK or not. My current and previous OS never mentioned alcohol ablation injections that I have both seen on the NHS.

Are you sedated for it? as i don't think i could stand being awake for it?

I have had 5 cortisone injections into my right knee and 1 into my right hip as the right knee injury has caused a labral tear that may have been caused by the way I am walking with a slight limp by putting more weight onto my right hip due to anterior knee pain. I have always been awake while given the injection. It might be different if he injection was into the spine that's very sensitive that needs precision when injecting just like the knee but more risky by the spinal chord! Can ask for semi or light sedation if you are feeling nervous, I would not advise to have a full GA, it's a lot for the body to go through! It is not always the best option to go for if the procedure is short and straight forward.

It is hard to accept when you are told your knee problem is hard to get right again when you are feeling pain and discomfort daily with limited mobility. Surgery can sometimes work out well for fat pad impingement if you find a OS that specialised in fat pat problems of the knee with the correct PT sessions post-op can lead to an improvement in mobility and reduction in pain and discomfort.

Good luck with whatever you decide to do next, you have found the right support group by joining KG you will get great advice and much needed moral support and understanding from members with similar knee problems.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline lucykneepaingoaway

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #10 on: June 30, 2017, 10:49:18 PM »
Maybe that's what you need to do next, orthopaedic surgeons all have sub specialities, even if they specialise in knees

Where do you live? There are a few patella specs in the UK (are you in the UK?)

hi
yes i'm in the wesr midlands. i'm scared about seeing a surgeon again as i don't want them to blame everything on my weight again.
i have felt so down with everything- i have felt suicidal with this knee pain.

Offline lucykneepaingoaway

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #11 on: June 30, 2017, 10:50:51 PM »
hi all

i haven't tried the taping- i might ask my Physio.
The orthopaedic surgeon I saw trivialised my problems & pain & said it was a weight load problem & it would be sorted in 4 months. he blamed everything on my weight pretty much! This totally depressed me as i take appetite stimulating drugs- like anti depressants which cause weight gain. Being so immobile, its hard to do any exercise. Most i can manage is to swim.

The alcholol ablation/ nerve block thing- link is here: https://qpain.com.au/wp-content/uploads/Genicular-Nerve-Procedures.pdf

thanks for all your help & replies.

I feel like i'm going in circles.

I didn't find about alcohol ablation, only steroids injection. Alcohol injections that is ethanol injection not steroids.
I am looking also for ethanol injections.
You can read here:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=14629.0


hi

I called the London pain centre & they said noone does alcohol ablations.
i'm going to try & look into it further.
thanks
x
 

Offline lucykneepaingoaway

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #12 on: June 30, 2017, 11:00:52 PM »
hi Clarkey

thanks for your message.
sorry to hear of your trouble too.

I had a labral tear in my hip too & a cam lesion.
i got the best relief from having a hip arthroscopy where they shaved the bone & got rid of lesion. hip feels a lot better now.

the reason i asked about the sedation about knee injection/ neeve thing is when i had my hip diagnostic injection, to see if i needed surgery- they put me to sleep & sedated me which was much better than being awake.
when i had my cortisone in my knee awake- it killed :(
nurse did it really slowly, it hurt going into the capsule bit-
and didn't do anything for my knee pain.
i am thinking cortisone shots in the knee fat pad won't be as good as alcohol ablation as surely they don't get to the nerves.
my ohysio said the injections were available on nhs- but don't know if this is for cortisone shots injected in the kneepad or alcohol ablation injections that kill off the nerves in knee.
he mentioned about killing off nerves you see, so am thinking/hoping its ablation method.

i keep doing this daily exercises & my knee is going straighter- but it still hurts
 
thanks Clarkey

lucy x

Offline Aly0108

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #13 on: June 30, 2017, 11:36:16 PM »
Hello,

Today I visited a Sport medicine, He gave me a cream simple Multiprofen CC plus, and Celebrex 200 mg.

Offline Aly0108

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Re: ablation or fat pad removal for fat pad impingement pain?
« Reply #14 on: June 30, 2017, 11:39:30 PM »
hi Clarkey

thanks for your message.
sorry to hear of your trouble too.

I had a labral tear in my hip too & a cam lesion.
i got the best relief from having a hip arthroscopy where they shaved the bone & got rid of lesion. hip feels a lot better now.

the reason i asked about the sedation about knee injection/ neeve thing is when i had my hip diagnostic injection, to see if i needed surgery- they put me to sleep & sedated me which was much better than being awake.
when i had my cortisone in my knee awake- it killed :(
nurse did it really slowly, it hurt going into the capsule bit-
and didn't do anything for my knee pain.
i am thinking cortisone shots in the knee fat pad won't be as good as alcohol ablation as surely they don't get to the nerves.
my ohysio said the injections were available on nhs- but don't know if this is for cortisone shots injected in the kneepad or alcohol ablation injections that kill off the nerves in knee.
he mentioned about killing off nerves you see, so am thinking/hoping its ablation method.

i keep doing this daily exercises & my knee is going straighter- but it still hurts
 
thanks Clarkey

lucy x

You need keep your inflammation down. I took a lot medication to keep inflammation down.















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