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Author Topic: Which service / surgeon should I choose - PF issues  (Read 93 times)

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Offline EsmieP

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Which service / surgeon should I choose - PF issues
« on: May 17, 2019, 11:28:43 PM »
Hello there. Would really appreciate some advice. I had a patello femoral replacement in 2014 on my left knee after years and years of recurrent and numerous kneecap dislocations. I went to see the doctor repeatedly and was told there was nothing wrong and was sent for physio over and over for years which never helped and I was continually fobbed off. Go forward 22 years (from the age of 16 to 38) and I was eventually referred to see a consultant in Bristol who is a patello femoral expert (Dr Eldridge). i was told that there was so much damage to my knee at that point that the only choice for me was a patello femoral replacement. So despite my apprehension I went for it. For a year after the surgery, and almost immediately after the surgery, the result was absolutely amazing. I was totally pain free, totally dislocation free and I could do things that I'd not been able to do for years, It was amazing, i could not have wished for a better result. I was hiking 14 miles without any issue. On my check ups they told me I had made a miraculous recovery, especially with my flexibility.

However about a year  - 14 months in, I started to develop pain and the kneecap started to "crunch" a little. I went back to see the consultant (but saw his registrar as he wasnt available) and was told that this was all normal for such a big op. I was told there was nothing wrong. I protested that it had not done this for a year after the op and was told there was no issue. I came away feeling doubtful. The pain and crunching got gradually worse. The following year, I went for the annual check up and saw the consultant . He immediately told me that my kneecap was too high and needed to be lowered. When i questioned this and asked why it had been fine for a year and why the registrar the previous year had told me all was fine, i was told I had "just been unlucky". There was little explanation provided and it didn't make any sense . I was told that I needed an osteotomy to lower the kneecap and that this was major surgery. I doubted this given that the knee had been absolutely fine for a year and so I didn't proceed. It just didn't make sense and my questions were not answered. The consultant shrugged his shoulders when I pressed for more information.

I eventually got referred back to my GP. So am starting again. I would like a second opinion on what the issue is with my knee. I was told I need the same surgery on my right knee but do not want to proceed with this until my left knee is sorted. I also had new mri scans recently ordered by my GP and was told there was nothing wrong with either knee! I know this is not correct and so I am being referred to a consultant again for a second opinion. My question for the forum  is which consultant should I choose for a second opinion? I have done some research and have found Neil Bradbury in Bath, who seems to know a lot about PF issues or there is Andrew Porteous in Bristol who is very highly regarded as one of the top knee surgeons in the UK , does a number of complex knee revisions but has fewer PT replacements under his belt it seems. He also works with the original consultant i believe so am not sure would be impartial? Can anyone provide some advice with regards to which hospital / surgeon to choose? I am desperate to get these issues sorted and really want to choose the best person for the job who will give me some accurate advice. Thank you.

Offline Vickster

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Re: Which service / surgeon should I choose - PF issues
« Reply #1 on: May 18, 2019, 08:32:42 AM »
Thereís a list of surgeons recognised as PF specialists here, just a few in the U.K. of whom Jonathan Eldridge is one.

https://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-patellofemoral-surgery

Are you able to go private (Mr Bell on the list is private only for example) and also to travel as that may open up your options? Indeed, Iím not sure whether you can actually guarantee seeing a specific consultant or only secure a referral to a specific hospital trust (a question for your GP doing the referral)

You could also consider a senior surgeon such as Prof Barrett, again private only
http://www.professordavidbarrett.co.uk/about/

An other option (which is one I'd probably try first if wanting to avoid surgery) is to get a thorough assessment from a Consultant physio to confirm that the issues are definitely structural (which would normally show on X-ray or MRI) and thus potentially surgically correctable and not more muscular / due to imbalance or tightness. Again, private only, but Claire Robertson in Wimbledon might be worth considering (she works with Jonathan Bell if you do need to see a surgeon)

Have you been seeing a physio at all?

Good luck :)
« Last Edit: May 18, 2019, 09:09:46 AM 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 Brandon123

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Re: Which service / surgeon should I choose - PF issues
« Reply #2 on: May 19, 2019, 12:47:44 PM »
The following year, I went for the annual check up and saw the consultant . He immediately told me that my kneecap was too high and needed to be lowered. When i questioned this and asked why it had been fine for a year and why the registrar the previous year had told me all was fine, i was told I had "just been unlucky".

I think this is the really strange part, and where you need to get some real answers. Have you developed patella alta (high riding knee cap) after the PFJR? Sounds odd but maybe not impossible, I don't know really. Or did you have exactly the same patella height when going in for the surgery? Which sounds more likely to me, but as stated, I don't know if you can develop patella alta after a PFJR, so this is something you must discuss with a PF expert. I guess you have X-ray/MRIs from before the surgery, which then can be compared for patella height with your latest images. Key here is of course to sort out if your patella height has anything at all to do with these recent problems you're experiencing. You don't want to have an osteotomy if you really don't need to.
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 EsmieP

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Re: Which service / surgeon should I choose - PF issues
« Reply #3 on: May 19, 2019, 01:33:43 PM »
Thank you both so much for your responses. Brandon, I totally agree with you and those are good questions. It all seems odd and i don't want to have the osteotomy to lower the kneecap if it's not what is causing the issue. The pain I have is towards the bottom of my kneecap not at the top and so this doesn't make sense. Surely if the pain was due to too high a kneecap, the pain would be at the top?

Vickster, yes I've seen a really good physio and he says I have muscle wastage in my leg that has had the PF replacement. However this has been caused by the fact I am unable to exercise as much as I would like due to the pain, rather than the lack of exercise causing the issues / pain. I was doing lots of exercise and walking and then it became painful. The physio says that he thinks my kneecap is not too high which casts further doubt over Dr Eldridges suggestion and supports my view. He gave me exercises to do but I struggle to do these because it is just too painful to do squats and lunges. This physio is not a knee expert however although he is very good.

Sadly I cannot afford to go private for surgery but would be willing to travel and would be perhaps able to just get an opinion from an alternative expert. I don't really want to go back to see Dr Eldridge as although he is one of the PF experts in the UK have lost confidence in him and he really wasn't willing to give me the time to discuss the issues. His explanation was literally that I had been unlucky. This isn't a good enough explanation for me. Hence looking elsewhere for another opinion. I had MRI scans on both knees in January which states that there was "significant artifact" due to the PF replacement and so the images were not clear enough to assess which is pretty rubbish really. I would hope that when I see another consultant that they will redo the MRI's / xrays. I asked about Neil Bradbury in Bath as he has done 40 PF replacements in the last 3 years and Andrew Porteous has done a fair few and is rated for doing revisions hence looking at these. Last time I specially asked to see Dr Eldridge and my request was honoured, although perhaps I was just lucky or maybe this was because he is the PF expert in Bristol!

Thanks again for your advice, I'm so frustrated and just want to get it sorted so I can start living a normal life again.

Offline Vickster

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Re: Which service / surgeon should I choose - PF issues
« Reply #4 on: May 19, 2019, 04:51:36 PM »
Maybe you could try hydrotherapy in addition to non loading land physio exercises. A much kinder environment for strengthening. Lunges and squats are very hard on the kneecap and best avoided if there's any weakness (non knee specialist physios always seem to recommend as the thing for knees without considering the load and the possibility of poor form making things worse).

When are you seeing the GP to discuss referral?
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 EsmieP

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Re: Which service / surgeon should I choose - PF issues
« Reply #5 on: May 20, 2019, 12:17:09 PM »
Thanks Vickster. I've seen the GP already and she just referred me to MATS (Musculoskeletal assessment and Treatment Service) which is "apparently" the only route in Bristol for GPs to refer. I'm not sure i believe this but not much i can do. MATs have reviewed my case notes without seeing me and have written to me saying they are referring me straight to a consultant under the EReferrals service. However they have only chosen the Bristol Royal Infirmary which is where I was seen before and is not a great hospital. When i log on to EReferrals to book an appointment online it states that there are no appointments available for me to book! Having done some research i understand that under the NHS I have a right to choose in which hospital I am seen. So I had planned to call MATs today to request a referral to either the Circle in Bath or the Spire / Nuffield in Bristol (depending on which consultant I want to choose) which are valid choices under the EReferals service. (the old choose and book) .