Experiences of PKR (Patellofemoral Replacement) appreciated

[myownlady]

Hi All,
I'm new to this forum, so sorry if a similar posting has been made before. Hope its in the right place.

I have been recently diagnosed with advanced patellofemoral arthritis in both knees (lateral compartment of both patellas have no cartilage left - its bone on bone - apparently this joint is dysplastic). The other compartments are ok. Thing is up until recently I have done a lot of cross country running, hiking and cycling. I am very active for my age (54). I have had to stop the running and hiking, my knees still seem to tolerate the cycling though as they don't swell up. And quite frankly until my legs fall off I am not prepared to give on everything.

After extremely depressing prognosis from 3 different consultants who essentially said all I can look forward to is pain, reduced activity levels followed by no activity after a replacement, I was wondering what peoples experience was with patellofemoral replacement? Which all the consultants were extremely dubious about.

Is it possible to return to activity after PKR? There is an extreme dearth of real life experiences on the web for people's experience of this treatment, particularly for younger or very sporting people. Any experiences appreciated, this is a life changing issue for me.

Hello! I was very uncertain about having my partial knee replacement. I am now about 5 months post op and couldn't be happier with the results. I have the Kinamed patello-femoral implant. Just make sure you do your PT exercises at home and don't miss an appointment with your physical therapist and you will likely do great! Good luck!

 

[mendogal]

Thank you for the update. I agree with your thinking re choosing the partial and the only real issue is finding a surgeon with good experience doing patellofems.

 

[EalingGran]

is three months since my Arthrosamid injections. Unfortunately the improvement has been extremely minor*

Sorry you haven't had any real benefit and are now looking at a PKR.
I see you are in the UK. If you are near London I would recommend my surgeon - Alex Liddle at Charing X ( NHS) and King Edward's VII ( private). He has done a lot of the research on partials and is a very good surgeon. He did my lateral PKR and managed to straighten my very valgus leg. I agree with others here that particularly for the rarer partials ( lateral and patellofemoral)- that it is really important to get an expert who does lots.
I am now very active for my age- can walk up to 20,000 steps/ day, look after a three year old, kneel etc. I have very good ROM- 150 degrees flex.

 

[ropeyknees99]

is three months since my Arthrosamid injections. Unfortunately the improvement has been extremely minor*

Sorry you haven't had any real benefit and are now looking at a PKR.
I see you are in the UK. If you are near London I would recommend my surgeon - Alex Liddle at Charing X ( NHS) and King Edward's VII ( private). He has done a lot of the research on partials and is a very good surgeon. He did my lateral PKR and managed to straighten my very valgus leg. I agree with others here that particularly for the rarer partials ( lateral and patellofemoral)- that it is really important to get an expert who does lots.
I am now very active for my age- can walk up to 20,000 steps/ day, look after a three year old, kneel etc. I have very good ROM- 150 degrees flex.

Thanks.

Saw my GP today with a view to him referring me on the NHS to a specialist. I went in all prepared as to why this needs to be so, as there is no way if you saw me that you'd clock I have anything wrong with my knees. But fortunately he had read all the notes from the various clinics and specialists I've seen and he immediately said he would be referring me. Its not a decision I take lightly, particularly as I get about ok, its only really the sporty stuff I've had to stop, but this is depressing me and I definitely feel that although my recent Arthrosamid injections mask some of the symptoms it has not arrested the decline of my knees, mainly evidenced when I walk down stairs, which is my key metric.

I get the idea that very few specialists have much to do with partial replacements and even fewer anything to do with patellofemoral replacements so the choice is really important. I quite liked the last chap I saw, who oversaw the Arthrosamid injections as apart from the GP he has been the only medical professional who didn't think I'm bonkers wanting replacements over "conservative" treatments. Will bear the name above in mind, as I think I have some choice of consultant on the NHS, or if I am not happy the private option always exists.

 

[Gammy Knee]

Hello,

I’ve read your thread with interest. I also suffer from PO but medial side of my left knee, I’m 35 and have a history of knee dislocations from football. Ive followed the NHS and private route and consensus is conservative management and don’t even think about any type of replacement, which I fully agree with and understand that I need to have a long stretch of physio to see of any improvement before considering other options. I had steroid injection but with no effect.

I’ve been doing my ‘conservative management’, for approx 4 months now, this consists of 4 x gym sessions per week where I can do all exercises (squats, lunges etc) with heavy weights and light exercises/stretched at home, I’m having success with building the VMO and my overall leg strength is significantly improved, but I’m only seeing slight improvement with my knee, basically that it swells up less on a day to day basis, but is still swollen up at the end of most days, is slow to walk on and going down stairs is impossible, even though I can do exercises fine that imitate the action of going down stairs.

I’m considering taking a couple of months off work to really push the physio work, I work in construction site management so it is a mixture of walking around site (which I haven’t been able to do) and working in the office (which I struggle with due to knee being bent most of the day resulting in swelling), overall I’m struggling with work but have no clue as to whether the physio work will improve me significantly overtime. My dad has had bone on bone OA for years and has lived with it fine, baffles me why mine gives me so much grief.

I’m guess I’m not really asking for any advice, this may sound horrible but it’s not meant to be, it helps to read about other people with a very similar issue. I can’t really talk to anyone about my knee as I feel I’m just annoying them and dragging them down. I do try to stay positive, although you might not believe it from my post ;)

 

[mendogal]

Welcome to BoneSmart @Gammy Knee !

My main suggestion (unsolicited I know...) as you pursue conservative treatment is to lightly warm up your knee before physio and then elevate and ice a good 45 minutes if you can (safe if you protect skin with a layer of fabric). This will reduce inflammation and pain

 

[ropeyknees99]

Hello,

I’ve read your thread with interest. I also suffer from PO but medial side of my left knee, I’m 35 and have a history of knee dislocations from football. Ive followed the NHS and private route and consensus is conservative management and don’t even think about any type of replacement, which I fully agree with and understand that I need to have a long stretch of physio to see of any improvement before considering other options. I had steroid injection but with no effect.

I’ve been doing my ‘conservative management’, for approx 4 months now, this consists of 4 x gym sessions per week where I can do all exercises (squats, lunges etc) with heavy weights and light exercises/stretched at home, I’m having success with building the VMO and my overall leg strength is significantly improved, but I’m only seeing slight improvement with my knee, basically that it swells up less on a day to day basis, but is still swollen up at the end of most days, is slow to walk on and going down stairs is impossible, even though I can do exercises fine that imitate the action of going down stairs.

I’m considering taking a couple of months off work to really push the physio work, I work in construction site management so it is a mixture of walking around site (which I haven’t been able to do) and working in the office (which I struggle with due to knee being bent most of the day resulting in swelling), overall I’m struggling with work but have no clue as to whether the physio work will improve me significantly overtime. My dad has had bone on bone OA for years and has lived with it fine, baffles me why mine gives me so much grief.

I’m guess I’m not really asking for any advice, this may sound horrible but it’s not meant to be, it helps to read about other people with a very similar issue. I can’t really talk to anyone about my knee as I feel I’m just annoying them and dragging them down. I do try to stay positive, although you might not believe it from my post ;)

Sorry for not replying before, I haven't visited the forum for a while.

The surgeons are very reluctant to operate, I think that is the root of the emphasis on conservative options. I've seen a number of specialists, one of whom told me to forget about outdoor sports and go swimming instead. What they are trying to do is work out how determined you are to do something about the issue rather than accepting it for what it is. That doesn't seem unreasonable to me, the surgical options all seem pretty horrific.

My take on physio for patellofemoral arthritis is that it is pretty much a waste of time for an otherwise fit active person, mainly because there are hardly any exercises that can be done that don't aggravate the symptoms. I reckon if I could deadlift I'd achieve what I have in 2 years of going to the gym in 2 weeks. About the only one I can do is a standing wall squat, but when you can sustain that at a 90 degree angle for 15 minutes at a time there is no where else you can go with it. Overall, I'd say its made very little difference, probably because my knees are too far gone.

I've had PRP/hyaluronic acid which did very little and Arthrosamid, which did nothing for 4 months and has given me a slight improvement after that. It has enabled me to be a bit more active, although my knees rebelled after a 16km walk I did recently on the downs near where I live and were swollen for about a week afterwards.

I've discussed the surgical options with the consultant and rather than a partial replacement (the other parts of my knee are in good shape, so I will likely never need a full replacement from mechanical wear), we are going to go for a Tibial Tubercle Osteotomy because the tracking in both knees is out - this is what caused the damage in the first place. I am moderately optimistic of a good outcome because apart from the outer edge of my patellas, which the surgeon is going to cut away there is still some cartilage in the middle and the inside bit is essentially factory fresh because its never had any wear.

Even if it doesn't give me relief, I assume that fixing the mechanical issue will mean a later partial replacement would work better. Anyway I've got a fun 6-9 months ahead of me as both knees need doing.

Good luck, I don't have much advice except do what you think is right for yourself and don't let yourself get fobbed off. In my case, the risk of surgery to be able to participate in the outdoorsy stuff I like doesn't seem a risk at all when if you do nothing you can't do it anyway.

 

[Gammy Knee]

Hello,

Thanks for your response.

My situation/diagnosis and suggested surgical options sound very similar to yours.

Since my post in January, I have made a significant improvement. I am in the lucky position that I do not suffer much pain and have full range of motion when knee is not severely swollen, which used to happen on a daily basis no matter what I would do. I’ve been continuing with strengthening all areas of my legs and am now in a position where I can walk normally and sit with the knee bent for a long period without any swelling. I’ve reluctantly accepted the fact that I won’t ever run again and most likely not play golf, I’m just happy to have got to where I am without surgery.

I guess I’m posting as a good news story, to give hope to people in similar situations,
(I found good news stories few and far between when I was browsing previously). Looking at the state of my knee last year, I never dreamt my knee would improve so much.

 

[ropeyknees99]

Hello,

Thanks for your response.

My situation/diagnosis and suggested surgical options sound very similar to yours.

Since my post in January, I have made a significant improvement. I am in the lucky position that I do not suffer much pain and have full range of motion when knee is not severely swollen, which used to happen on a daily basis no matter what I would do. I’ve been continuing with strengthening all areas of my legs and am now in a position where I can walk normally and sit with the knee bent for a long period without any swelling. I’ve reluctantly accepted the fact that I won’t ever run again and most likely not play golf, I’m just happy to have got to where I am without surgery.

I guess I’m posting as a good news story, to give hope to people in similar situations,
(I found good news stories few and far between when I was browsing previously). Looking at the state of my knee last year, I never dreamt my knee would improve so much.

I had my surgery yesterday (Tibial Tubercle Osteotomy) on my left knee. The strange thing is that I experienced a complete divergence of my symptoms over the past 6 months. Activities round the house such as DIY and gardening have got easier and I get less stiffness and swelling. "Athletic" activities have got progressively harder. My manual pedal cycles are now retired and I recently bought an ebike. But even so I reckon you can draw a straight line to when any recreational activity will be impossible even with power assistance. So for me having the operation was a no brainer (still need the opposing leg done).

I think if you have seen an improvement and you are happy with the activities you can partake in then risking surgery doesn't make sense. For me such a risk isn't a risk when within 2-3 years I face the extinction of being able to do any outdoor exercise.

As it happens the surgeon was extremely positive about the operation, he said the knee cap tracking was miles out and and he has been able to correct it without needing a facetomy on the lateral edge of the patella. Although early days 11 hours after a post operative morphine injection I was almost completely pain free, although I expect things to get worse so have taken ibuprofen and paracetamol prophylactically. I am crossing fingers for a good outcome as its been a grim few years of ineffectual treatment, physio exercises that make things worse and a procession of consultants who think at 56 I should be happy if the limit of my activity is walking down the shops to buy a loaf of bread.

 

[Layla]

Hello ropeyknees99,
Wonderful to read you are now post op and your OS feels good about the surgery. I hope the pain remains manageable for you and the outcome positive.

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@ropeyknees99