Revision TKR _My Saga of a Hopeful Happy Ending - Nerve Burning??

[Pumpkin]

Nancy,
Sorry to hear you are still going through trouble with your knee.
@sistersinhim has had both her patellas removed, and is doing great. She will come along and tell you her story.

 

[sistersinhim]

So my surgeon says, there is no patella replacement.

He could always remove your patella. I have had both of my kneecaps removed, one in 1991 and the other in 1993. I'm doing fine without them. The few things I can't do, don't hinder me at all. I can't squat, which I wouldn't do anyway! Jumping is out. That, too is no big deal! My knees are somewhat weaker than the complete knee, but it hasn't stopped me from doing the things I love to do. The best thing about having no kneecaps is that I have no kneecap pain!

 

[skigirl]

Nancy, I am so sorry to hear that you are still going through so much. If you ever want to have Mayo look at your knees, you can stay with me in Minneapolis and drive down to Mayo quite easily. You almost need some real specialists who have seen it all right now. I live alone and have a guest room, in fact it would be fun to have your visit me in Minneapolis---I live right outside of Minn in a town called St. Louis Park. I am serious, I think it is time to get some real experts in problem solving to look at your knees.

 

[LaPaz]

sistersinhim, thanks for sharing your experience with removing of the kneecap. When you say you can not squat does that mean you can’t go down on your knees? Or bend your knees to reach something?

 

[LaPaz]

skigirl, that is so kind of you and I may take you up on it. I’m going to give it a little more time as my doctor suggested and also he put me on a different anti inflammatory Monic (Meloxicam). I had not been taking much ibuprofen as I am scared of the damage it could do from years of taking it. I am not keen on this drug either but he felt I really needed to take an anti inflammatory. He also told me to try Turmeric a natural inflammatory along with this drug. My right is still a problem so maybe the clinic would have more expertise to what my future steps should be.

 

[sistersinhim]

Yes, I can bend my knees to pick up stuff. But, I can't go all the way down and sit on my heels. I'm too big for that anyway. I can get on my knees, but it's very uncomfortable. When I have to get on the floor and then get back up, I turn over almost on my tummy and walk up with my hands with my butt in the air. It's not a pretty sight, but we do what we have to do!

I've adjusted quite well to not having kneecaps for the last 20+ years. Getting rid of that constant kneecap pain was a blessing, so my 'disability' from it was well worth it! If yours has to be taken, you will do just fine!

 

[LaPaz]

With both my knees already replaced removing the kneecaps maybe a different story. I see you never had TKR. I’m just like you with what I can’t do after my TKR.

 

[sistersinhim]

I have had a tkr on my right knee. Check out my signature and you're see it's the top line. The only difference if your patella has to be removed, is the patella tendon will have to be shortened.

 

[Josephine]

So my surgeon says, there is no patella replacement. What happens when you destroy your patella and it can’t be replaced?

He's right. There is no such thing as a patellar replacement. Let me explain to you why.

The patella is what we call a sesamoid bone, meaning it's a small bone that grows inside a tendon or ligament where there is pressure from a bone it's riding over. We don't just have them in the knees but also in the great toe and sometimes even the thumb!

In the knee, these bones grow within the ligaments - the quads above and the patellar tendon below - and the position of it is maintained by the tension of those ligaments. They also have a small area of articular cartilage on the back

If the patellar is fractured, it can often be repaired using a tension band wiring like this

But if it is not salvageable, then the only remedy is for it to be removed and the two tendons stitched firmly together but this inevitably shortens the length of the quads so kneeling can be difficult.

 

[skigirl]

Nancy, I really meant it, so don't hesitate to just tell me when you need to come. I think a top rated hospital like Mayo may have more options for you. I picked Mayo because it is near me. The hospital for special surgery in NYC or Rush in Chicago are some other places to look at. But, here you have a free place to stay.

 

[LaPaz]

Kelly, you're fantastic! I hope I don’t have to but it sure makes me feel better knowing the options. I will keep you posted.

Thank you for this information. I definitely needed to know my options and what I may need in the future if the pain remains. What type of surgeon would specialize in patella surgery? I have had so many problems and don’t want to risk any more complications. As you know I have had multiple surgeries. Kelly suggest the Mayo Clinic near her but how do I find out who would specialize in this so I could contact them.

 

[Pumpkin]

Nancy,
You could contact them directly and ask if they have someone who specializes in the type of problem you have. You can also go to their web site and read the physician biography's.

I can obtain the name of a surgeon at Stanford, @PegGar16 had her knee/kneecap re constructed at Mayo in Phoenix.

 

[LaPaz]

That would be nice. Phoenix is not to far from me.

 

[Josephine]

What type of surgeon would specialize in patella surgery?

Nancy, that's a bit like asking what kind of general surgeon would specialise in appendectomy!! All orthopaedic surgeons should have experience with patellar surgery

 

[LaPaz]

Update on my knees... Kelly recommended the Mayo Clinic. I contacted the MC in Phoenix and sent all my records of past surgeries. The surgeon replied that he could not help me but I was recommended to contact the MC in Minnesota. I found a doctor that I sent all my records to and he felt he maybe able to help me. My appointment is end of Nov.

My concerns are with my left kneecap which my last surgery my OS was not able to replace the button or smooth out the bone spur due to the fragile condition of my kneecap. I am hoping this surgeon may have a technique to remove the button without breaking the kneecap. My pain in this knee has worsen.

My other concern is my right knee which has had several revision due to looseness. My OS feels my pain and discomfort is from scar tissue build up and felt to open the knee would more than likely just cause more discomfort. I am hoping this surgeon may be able to help relieve some of the discomfort I have. Even if he could help just one knee I would be happy.

I have a lot respect for my OS but since he has told me that he can’t do anything more without the risks of making things worse I have turned to other opinions from surgeons that specialize in problem knees.

Presently, I am unable to navigate stairs without pain and support. I have to support my knee to get into and out of a car and to straighten once in the car. I can only walk short distances without pain. I can’t sit in a chair without supporting myself or I fall into it. My range of motion is still ok. I can ride my bike (45min), swim/water aerobics, dance but I need to ice, elevate and take anti inflammatories and sometimes wear an elastic knee support to help relive the pain. My pain is not constant and if I chose a life of sitting and light exercising I would probably be ok but not happy. I’m athletic and enjoy staying fit. I have my fingers crossed and will let the community know the outcome.

 

[Pumpkin]

LaPaz,
Thanks for the update, hope you find some answers at the Mayo Clinic. Sending your positive thoughts for your appointment in November.

 

[sistersinhim]

Fantastic that you have an appointment at Mayo. Things are looking up!

 

[skigirl]

I do hope this works, they do have a reputation of being experts for problems.

 

[LaPaz]

Josephine, I’m reviewing your post and have some questions.
If they need to remove my patella you say it will shorten my Quads. Does that mean I will not be able to regain my present ROM? How about the tension band will it affect my ROM? I can ride a bike but if I loose ROM I would no longer be able to ride my bike. That Hurts! Also, would stem cell injection or implants help the patella to repair itself? I would like to understand these options prior to my Mayo Clinic appointment so I may further discuss with the surgeon. Thanks

He's right. There is no such thing as a patellar replacement. Let me explain to you why.

The patella is what we call a sesamoid bone, meaning it's a small bone that grows inside a tendon or ligament where there is pressure from a bone it's riding over. We don't just have them in the knees but also in the great toe and sometimes even the thumb!

In the knee, these bones grow within the ligaments - the quads above and the patellar tendon below - and the position of it is maintained by the tension of those ligaments. They also have a small area of articular cartilage on the back

If the patellar is fractured, it can often be repaired using a tension band wiring like this

But if it is not salvageable, then the only remedy is for it to be removed and the two tendons stitched firmly together but this inevitably shortens the length of the quads so kneeling can be difficult.

 

[skigirl]

@Josephine Nancy asked you some questions in the post above this one and did not tag you, so I thought I would.