Knee Replacement & Hip Replacement
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Patella not tracking!

Discussion in 'Knee Replacement Recovery Area' started by bionicman, Aug 26, 2011.

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  1. bionicman

    bionicman New Member

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    Post #1 on Aug 26, 2011
    I am 4 months post-op today from having TKR. I have had 2 manipulations and my range of motion did not maintain. I have had 46 therapy sessions and I have done everything above and beyond the call of duty. I am 40 years old and have a lot of living to do. I did not feel that I was getting the answers from my doctor that explained my complications. My therapist told me that there is no way I should be not getting better based on my work habits during therapy.

    I decided to get a second opinion and make the trip 2 hours away to the Hartzband hip and knee center which is a highly reputable group in NJ. After a consultation with the doctor they took new x-rays of my knee. It was at this point that the doctor showed me a view of my knee that my other doctor had never shown me before. It was this view that the doctor explained to me that my patella was not tracking properly due to misalignment of the tibial prosthetic by approx 3.6 degrees. He showed me an x-ray of what it should look like and explained to me that if was not corrected I would never improve my range of motion and I would be stuck around 90 degrees.

    I was shocked by what I heard and am still trying to take it all in. The idea of having to do this all over again makes me nauseous. I have lost 4 months of my life that I will never get back and will lose 3 more most likely. I am slightly relieved to get an answer to my problem but not just the one I wanted. My other doctor just kept telling me it was scar tissue holding me back. After doing a little research apparently this is the most common cause of failed knee replacements. I'm still not 100% sold on what I'm hearing.

    To make things more interesting I tried to get a 3rd opinion with the Rothman Institute another highly reputable group but to my concern they will not re-evaluate knee replacements for 1 year post-op. That makes me think is something going to change if I wait. My original doctor said it could be scar tissue pulling the kneecap out of place. At this point I am going to get a 3rd opinion and go to the hospital of special surgery in New York. I really want to make sure I am doing the right thing before I opt to do this all over again. I said I would never do this again If I needed to replace my left knee and here I might have to do my right knee twice in a short period of time. Any insight would be appreciated. :cry:
  2. chuck172

    chuck172 Member

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    Post #2 on Aug 26, 2011
    I think HSS is your best bet. Consider them the final word on your possible problem.
    I'm 6 weeks post op. with Dr. Russel Windsor at HSS. Get an appointment with him or any other Dr. who operates out of this hospital as soon as possible. Hopefully its a scar tissue problem. Good Luck!
  3. ChefHuber

    ChefHuber Member

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    Post #3 on Aug 26, 2011
    I'm sorry to hear you are having so many problems. My OS commented to me how important getting the alignment correct is or the replacement won't work properly. Sounds like that is what is going on with yours. You certainly can't live with 90 degrees ROM for the rest of your life. You may find that a fixed knee won't set you back 3 months. Consider the few months set back a small price to pay for a life long investment.
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  4. Jamie

    Jamie

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    Post #4 on Aug 26, 2011
    Bionic, I think you are being very wise by seeking out another opinion. And not in a year, either!!! I know it is not what you want to hear if you find out the first surgery was not done well. But, better to know that now and get it fixed than to wait and keep your life on hold.

    Please do let us know how things go. We're here for you!!!
  5. Josephine

    Josephine

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    Post #5 on Aug 27, 2011
    Considering what you've been told in regard to the new xray, it very much sounds to me like a malaligned implant. If it was scar tissue, it would have changed in degree over the weeks. And that the results of the MUA were not retained is also suspicious.

    However, a revision won't be quite as devastating as the original surgery as there will be no bone cutting or at least, very little.

    But do keep on and find yourself that 3rd opinion. If it is a malalignment, making you wait another 8 months or more is not going to help the soft tissues. You want it dealt with before they start to react badly.
  6. carousel66

    carousel66 Graduate

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    Post #6 on Aug 27, 2011
    Bionic
    you I echo what others say, I don't have the medical background but I'm young (lol - it is the only place in my life I can say I'm YOUNG lol seems nutty to type it lol giving myself a good laugh :hysterical:)
    ( -- back on track)
    In short I can understand the feelings of wanting your life back. That is what my LTKR gave me! you will get there, the journey is just a bit longer.
    while I'm not in the same situation I'm facing a RTKR MUCH sooner than I ever expected in my wildest dreams. my LTKR gave me a TASTE of having my life back, but then my my R knee started to fall apart FAST - I figured I had some good "years" before I was faced with the decision of a RTKR, instead it was about 5 or 6 good weeks :scratch:

    So I'm also facing another TKR just with the other leg.
    Hang in there, you are young, and you ARE going to get your life back, just not as soon as you hoped. But it WILL happen.

    All the best
  7. Recycled

    Recycled Senior

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    Post #7 on Aug 27, 2011
    Bionicman,
    You are one of the reasons I try to read as many posts as possible. And why BoneSmart is so beneficial. I've had both of my knees done and I have.....am going thru the typical doubts and concerns when things feel too slow or issues pop up. I have had a few and some have resolved.

    But your explanation about the patella not tracking and the type of pain and then the type of Xrays. Well, with our surgeries and recoveries, we have to be our own advocates when trying to find the answers. The Docs can be somewhat reluctant to divulge bad outcomes of their surgery. Your information gives me and others something to go on when evaluating our own issues.

    I hope you get your knee resolved correctly and stick with the forum to keep us posted. I'm looking forward to hearing about your progress.
  8. Josephine

    Josephine

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    Post #8 on Aug 27, 2011
    Just been able to find the appropriate xrays for this - called a skyline or profile xray.

    This one is normal
    [​IMG]

    This one isn't!
    [​IMG]
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  9. bionicman

    bionicman New Member

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    Post #9 on Aug 27, 2011
    Josephine,

    Thank you for providing me with these x-rays. I was not sure what the terminology for this view was. I was just able to show my wife what the doctor showed me. I am concerned because the one that is bad does not look as bad as mine. My knee cap was pushed all the way to the left looking at it as if it was hanging off a cliff. I am going to get that 3rd opinion asap. Thanks again!
  10. Jamie

    Jamie

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    Post #10 on Aug 27, 2011
    :thumb: Good for you!!!
  11. Greda

    Greda Graduate

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    Post #11 on Aug 27, 2011
    Bionicman,
    I totally understand your frustration. I decided in Nov 2010 I would schedule my PKR. My OS couldn't get me in until 3/1/11 for the surgery. Everything seemed okay then things just didn't improve. I had more pain after the surgery than before. Less than 4 months after I had to have a revision because things had loosened. I was shocked that I was going to have to do it all over again. The part on the femur had to be replaced and more bone cut. It was not as bad as I thought it would be. I was surprised the recovery is the same but things seemed better because it was not loose anymore. I am glad I did it...though at the time I was angry and frustrated. I know everyone heals differently. I hope things work out for you. Try not to wait a year. I couldn't have done that. It seems like several OS want to wait and I don't know why.
    Good Luck,
    Greda
  12. Josephine

    Josephine

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    Post #12 on Aug 28, 2011
    bionic, that 'bad one' is a very mild version. But the best Mr Google could find for me!
    If you have your xray and can post it for me, I would be most grateful to be able to use it! (and see it of course)
  13. bionicman

    bionicman New Member

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    Post #13 on Sep 9, 2011
    I went back to my original doctor on Wednesday. He took a new set of xrays including the sunrise showing my kneecap being misaligned. He disagreed with my 2nd opinion to do a total revision. He said he has seen much worse patella tracking and that the doctor can not determine if the prosthetic is misaligned if they did not do a full leg xray from the foot up. He also asked me if the doctor told me that there is a 50% chance that a revision will be worse based on the study's. He said it was absurd for the doctor to guarantee me range of motion. He's very confident that it is a scar tissue issue and that if it was a misalignment problem he would not have been able to bend my leg where my foot touched my butt during two manipulations. His recommendation is arthroscopic scope to remove scar tissue along with a lateral release to move the knee cap into place. Outpatient procedure that is alot less risk for infection and other issues according to him. I have always trusted this doctor for some reason. It is just my gut feeling I guess. My concern is that I just read that a lateral release takes 6 months to a year to recover from. Im just not sure what that entails. Will I be able to bend my knee and walk down a flight of stairs. Let's face it I'm not running a marathon and my football days are long over. I just need to get back to my normal routine of riding a bike and using an elliptical to stay in shape. Has anyone had this procedure or have any insight?
  14. Josephine

    Josephine

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    Post #14 on Sep 10, 2011
    That sounds much more reasonable to me! And I totally agree with him that no-one can, or should, confidently predict any outcomes from any surgery.

    But where on earth did you read that recovery from lateral releases take 6-12 months? :scratch:
  15. bionicman

    bionicman New Member

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    Post #15 on Sep 20, 2011
    Okay tomorrow will be one week since I opted for the arthroscopic scope and lateral release. My doctor said it went well and he removed alot of scar tissue and was able to get my kneecap to track better. I started therapy back the day after and had two sessions last week. To my surprise the pain was not as bad as I expected. My friday therapy session was very promising. Well Im not sure what happened but my pain level increased significantly over the weekend. My quadricep is so sore that I can barely move. It is much worse than the two manipulations I had. I have been elevating and icing as instructed since the surgery. The doctor told me he bent me during the surgery to 115 degrees. On Friday we reached 102 degrees and I was riding the bike much more comfortably. Yesterday morning I had another therapy session and we only reached 80 degrees. The pain in my quad was excruciating. I could not get the full rotation on the bike. I feel like Im stiffening up again and I have my concerns. Im so afraid not to try and bend this knee but at the same time my leg is screaming leave me alone. I could not even put my dynasplint on my leg yesterday. Im not sure what to do anymore. Does anyone have ideas on how to treat my quadricep?
  16. Josephine

    Josephine

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    Post #16 on Sep 20, 2011
    Arthroscopies are painful procedures, especially when you've had tissues cut. So long as you are moving it some, that will be enough for the time being. Adhesions won't reform that quickly and you have to let the new incisions settle down a bit first. Take your pain meds and ice and elevate.
  17. bionicman

    bionicman New Member

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    Post #17 on Sep 21, 2011
    Thanks Josephine. My wife keeps telling me the same thing. I just need to give it time I guess. Today was a little better day at therapy than monday so hopefully the progess will continue.
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