Lipogems-chondromalacia patella

[kneegeek2020]

Before I start this diary, if anyone who is reading this has personal experience involving Lipogems-PLEASE PLEASE post your experience.  For anyone who doesn't know what Lipogems is, it's a procedure where they liposuction fat from your hips (flanks), purify it, and then inject it into the knee joint.  I'm almost 6 weeks post procedure, but as I said before, it would be great if anyone who has had this done would add to my diary before I go into all the details.

[vickster]

Have you used the forum search function? Good place to start

[kneegeek2020]

Not sure why you would recommend I use the search function, I'm asking for people who have gone through lipogems to add to this section as a benefit to others who might go this route.   

[vickster]

The search function will give you threads of people’s experiences over the years.  On looking though no one has posted about Lipogems for a year or more however as it’s a pretty niche procedure (due to availability and cost).

Many people who have posted in the past will no longer be active on the forum also.

[kneegeek2020]

Again, I don't see the point of what you're saying but I believe you are trying to be helpful so no worries  .  I've read everything that has been posted on lipogems on kneeguru.  There's not much but was hoping by chance that maybe someone lurking could add to anything I might say.  I'm 5.5 weeks post lipogems, so far I've had what I would call a miraculous anti-inflammatory response.   I’m busy with work but will eventually fill in the details as I go.  Only downside right now is that I’ve atrophied from rest and I’ve lost maybe 8 inches of flexion in my left knee despite having the same amount of fat injected into each knee (and rk has full flexion)

[kneegeek2020]

This is just an update.  10 weeks ago I had 20cc hip fat injected into my knees via lipogems.  Prior to lipogems I lived with toxic inflammation in both knees, which I believe was related to a cleanout surgery I had, I won't be going into the back details as i don't like re-living the nightmare.  The inflammation was hell.  I had to live with an icepack on my knees literally icing every hour of every day for months.  A simple trip to walmart and my knees would heat up.  Movement down a few stairs and my knees would heat up.  A hot shower would require a double dose of icing afterward, the icepacks would be hot afterward .  I told my the surgeon who injected HA that I wore shorts to keep the inflammation away-he said he had never heard of doing that.  I was at a loss of what to do.  I tried changing my diet but that only lasted a week and I saw no results.  Tried every supplement known to man.  Tried NSAIDs.  Tried hyaluronic acid.  Tried a steroid.  Even tried a rheumatoid arthritis dmard even tho i don't have RA.  Tried using ultrasound combined with voltaren gel.  NOTHING worked. 

I live in the united states and health care is extremely expensive and lipogems isn't covered.  The kit itself costs 1300 dollars.  They hide their prices in the united states on the websites so I contacted every place i could find.  I also contacted an office in poland which had the absolute best price I could find which was 2700 u.s.  Unfortunately borders are closed.  Anyhow, I shopped around and even though it was extremely expensive, I did get the best price.

Back to the inflammation.  The daily inflammation I had is gone.  If I exercise too hard there may be an evening flare but a simple 5 minute icing knocks it out and it doesn't come back.  Before, I'd ice and the heat would immediately come back.  Now it stays away.  I keep touching my knees to see if they are hot, praying the inflammation isn't there.  It's not, my knees are actually somewhat cool right now and tend to stay that way when indoors.  I was a slave to the icepack before.  Now I am free.  I still get inflammation flares during sleeping hours (ironic-inflammation at rest) but by the time my morning coffee is done the inflammation is gone. 

As far as function, I started getting serious about doing my exercises a week ago.  One leg was badly atrophied before lipogems (arthrogenic muscle inhibition) and i lost even more muscle after lipogems because I basically sat on my but for 6 weeks.  The feeling of fullness is gone.  Full ROM is back.  It didn't cure my chondromalacia patella by any means.   I was hoping it would harden the cartilage and bring me back to pre-surgical health but it didn't.  However, inflammation softens the cartilage and chews it up so the cartilage is definitely doing better than before. The pain in my distal patella is gone and cracking seems to be less.  I will have to report back in future about any functional recovery I have.

I know there are a lot of people suffering on this site.  I hope this information helps someone out there.

[Brandon123]

Thanks for an interesting story, kneegeek!

I can relate to your (previous) relationship to the ice pack...

Please keep us updated on how things develop!

[kneegeek2020]

Brandon-just curious.  How did you get rid of your inflammation and was it really as bad as what I had (ie-resistant to everything).  How long did it last?

[Brandon123]

Brandon-just curious.  How did you get rid of your inflammation and was it really as bad as what I had (ie-resistant to everything).  How long did it last?

I haven't gotten rid of it yet, unfortunately. I keep it somewhat under control by not putting to much load on the knee/walking too much. But I lose muscle mass with that strategy, so a catch 22. My inflammation was/is maybe not as bad as yours, but not far from it during its worst flares (typically flares up after efforts to build quads). It has lasted approx. 5 years, with better and worse periods. Tried all sorts of conservative treatments, without any real successs. For example, hyaluronic acid was like pouring gasoline on a fire for me (careful with all injections since), and I've heard people experience the same thing with PRP. But then again, others have great success with injections like those. It seems to be really individual what helps who, maybe because sources of inflammation are sometimes different, or something like that. 

[kneegeek2020]

Interesting analogy (gasoline on fire).  Sounds like you know your stuff and have been through the ringer.  I feel for you.  It sucks they don’t yet have something that can be injected that toughens the cartilage, hopefully in future something will be created but I don’t think soon enough for us.

My logic with injections has been that a lot of sh*t was taken out or damaged in my knee during the cleanout.  So I’ve done what I can to ‘put it back’.  Damaged blood vessels-prp.  Synovium removed- hyaluronic acid.  Fat pad trimmed- lipogems.  In hindsight, I believe it was PRP which caused the extreme inflammation I had (the gasoline you could say).  But ultimately everything falls back to the bilateral cleanout surgery I had. Naively fell for the trap of doing both at once(still a daily regret which I’m working to get over/move on).  As I mentioned before, nothing has brought me back to pre-surgical form (had chondro before surgery but nothing like it is now).  All spilled milk at this point.

As far as inflammation tho, lipogems has been a true godsend.  Not having to use icepacks every hour, I’m free.  Cost an arm and leg.  You considering it?

[Brandon123]

As far as inflammation tho, lipogems has been a true godsend.  Not having to use icepacks every hour, I’m free.  Cost an arm and leg.  You considering it?

I have become a sceptic of all sorts of injections, but if your success story continues I might actually start to think about lipogems again 

How old are you? And what exactly was the nature of your patella cartilage damage? Wear and tear or traumatic injury? I guess all those factors also play a role in the outcome of lipogems (and all sorts of injections/treatments).

[kneegeek2020]

Yea I think that as far as inflammation goes the fat is the cure. I don’t believe it has any other benefits.  My expectations were too high so that of course leaves me a little down.  I believe that my results peaked around 4-5 weeks and that the effect is permanent.  Of course when I workout or overdo it I still get inflammation because my cartilage is soft and can’t handle much.  It would be interesting if they did a study in people with rheumatoid arthritis of the knees.

As far as history, history of trauma in a fall with development of uncomfortable pulling sensations in knee diagnosed as scar tissue.  Surgery to resolve that remains the worst injury of my life.  Looks like you haven’t gone the knife route for anything, I’m jealous.  I will check back in some months to give you an update. 

[Brandon123]

Well, I actually had an arthroscopy in 2009 (cleaning up the patella cartilage) which improved the situation a lot. In 2015 I was about 90% recovered and felt so good that I started to try to run again (the thing that started it all)...big mistake. The knee became worse than ever and yeah, I'm still trying to recover from that.

Anyhow, looking forward to your update! Fingers crossed!   

[kneegeek2020]

6 months post round 1.  Summary of everything previous
Prior lipogems-inflammation 24/7.  Ice pack usage every 30 minutes
Normal lipogems per my guy.-3cc each meniscus and 3cc superolateral infra-articular injection
Tx I had-20cc superolateral intra-articular injection
Post tx-5 weeks of limiting ambulation and stairs. Then general rehab with leg weights elliptical etc

Results
Daytime inflammation 90% gone. Done with ice packs.
Stairs- after more than 2.5 years. Can look normal moving down steps. Albeit slowly. This is what I am happiest about.
Nighttime inflammation-still bad
Mornings-stiff and painful but after moving a little it’s gone
Lipogems round 2

Theory- infrapatellar fat pad was damaged/majorly trimmed/injured during initial surgery.  The pad serves as a cushion between the patella and leg bones. I believe its the analogous to the meniscus between the two leg bones and serves as a protective cushion. Anyone who gets scoped will have some damage to the fat pad as the knife goes directly through it. I feel like my brain knows the cushion is gone and has limited my ability to regain guads to full Anyhow, I’ve read a lot about heel pad atrophy. Tons of case reports online about injecting fat and improvements in pain and function.  Similar story to mine (people saying surgery or cortisone injection result in arthritis)(cortisone melts fat btw) I can quote one lady as saying after bunion surgery that her toes were now straight but now she had terrible arthritis. She had a fat transfer and still has arthritis but her symptoms are mostly gone.

I’ve applied the same logic for my 2nd round of lipogems.  The surgeon who re-conned my knee thinks it’s a good idea, and he’s the only guy I trust. A different surgeon will be doing the lipogems

Tx-
3cc medial to patellar tendon/distal patella DIRECTLY into fat pad
4cc lateral to patellar tendon/distal patella DIRECTLY into fat pad
*each injection 1cc targeting different regions of fat pad.  Directly into pad this time in attempt to rebuild the cushion.
6cc superolateral infra-articular just for the hell of it kind of. As mentioned before, had 20cc just like this and it crushed the inflammation. There’s still some intra-articular healing to be done
Post op plan.
Limiting ambulation for 6 weeks
No stairs for 6 weeks (or sideways because stairs are ubiquitous)
*attempting to limit load on the fat graft
*I’ll probably make it to 5 weeks before I lose my mind like last time

5 days away now. Nervous, scared, but hopeful.  A previous user posted that the pain of treatments was nothing compared to the down and loss of hope when the treatment fails to live up to expectations.  At a minimum I think  lipogems will heal my fat pads and the nightly inflammation will be gone. MFAT (lipogems)is the most powerful anti inflammatory injection that I’ve had and I’ve had them all. At a maximum the arthrogenic muscle inhibition will disappear and my quads will return to form after 3 years.

Take care to anyone reading this. Will post again certainly.

[silver_maple]

kneegeek2020, did you do an MRI prior to the first round of Lipogems? It would be good to know if there is any structure modification 1 year hence. Certainly, reducing inflammation is a major win, hope it sticks. How's the chondromalacia patella, still on the soft side? Many here are eagerly awaiting an update, hopefully a positive one.