Grade 4 Chondromalacia

[JudyS]

Hi
Hippy here, pretty recovered at 3 1/2 months. Some pain in the butt and groin due to muscles, but overall pretty darn good.

ON to the knee on the same side (right). Saw the doc and posted then. He was discouraging about arthroscopic surgery, saying it does not really have a great outcome. Great for some, but...
Didn't want to have the surgery conversation until my hip muscles were stronger.

Of course I can't stand it.
Am I correct in thinking at this final stage of kneecap degeneration with a large bone cyst that partial replacement is the conversation he is delaying??
I had a ssecond cortisone injection last week. Helps a little. When I am hiking I know I am not walking properly , still trying to proctect the right side. Some man coming up behing me last week commented on my knock-kneed walking on the right side!!!!
He actually asked if I was Irish , he knew someone who was Irish and walked the same way. OK , I do always seem to meet interesting people on the trail!!!

Surprisingly after 27 years of obsessive running, all else in the knee looks normal (at least on the MRI. my hip looked pretty good too)

Through my research grade 4 is the end. It says a full thickness cartilage defect and abnormal signal in the patella marrow.

Hoping to hear opinions from the experts. Knee people

I have an apt on friday to see how the cortisone has done.

Thanks
Judy

 

[Rowdy66]

I don't really know what you are talking about. I had both knees scoped and it didn't help, didn't have any cartlidge in either knee so the next step was BTKR. Waited a year almost in terrible pain so I could lose weight and I did but I was stipid to have waited and gone through all that additional pain. Too late to change that now, just sooooo happy I live in a time where it is possible to have BTKR, to me it is just miraculous that I am able to once again do 'my thing'. Good luck to you though, I admire the courage of anyone who is brave enough after hip replacement surgery to go for knee replacement. Neither is a picnic. Rowdy

 

[Josephine]

Hi
Am I correct in thinking at this final stage of kneecap degeneration with a large bone cyst that partial replacement is the conversation he is delaying??

I would say you are correct! Very much sounds to me like a total is on the cards.

 

[AlaskanTKR]

Not sure about the grade 4 - but the chondromalacia is a big owie. My knee was a result of trauma and then scope, more trauma, scope, etc. I know he did clean up the knee cap at least once during scopes. All of the scopes were for cartilage issues in the lateral compartment. The TKR came as a result of the bones like totally collapsing on to eachother - especially the middle part. He wasn't sure about the knee cap prior to the TKR but it was really torn up so he smoothed it down and put in the "button". Sorry I can't be of more help - my guy wouldn't have done a partial or total due to the chondromalacia - he is extremely conservative (which has its pros and cons).

Good Luck - the pain under the knee cap stinks!!!!!
Hang in there!
MArianne

 

[hess]

Marianne is right, nothing is worse then the under -the-kneecap pain. I am the result of chondromalicia, and I too was at a level 4. My OS said that a partial would not work because they really do the trick if only one area is affected, and I was beyond that. I will say that the TKR has taken away ALL joint pain, and the under-the-kneecap pain is becoming a distant (but not too distant) memory! My right leg is a little behind the left, and part of me is hoping to hold onto it for longer, but another part of me is anxiously awaiting another TKR. Good luck to you in the future, you really are a trooper!
Hess

 

[Linda2]

Yep--the kneecap is the problem on my right knee. It really doesn't like to climb stairs or lift me up from a seated position. I wish it could be fixed without a TKR.

 

[beachcomber]

A bi-compartmental partial knee implant was approved in the last few months which would replace only the patellar-femoral compartments. I was reading about it last spring when my OS said my 'scope showed both medial and patellar OA. I just googled it to find it. Might be worth an investigation and being in socal you probably have good resources available....

 

[Simon]

I developed Grade 4 chondromalacia by my mid 20's. Mine was caused by patella malalignment that lead to numerous patella subluxations (partial dislocations). It did not help that I played sports like volleyball, ran and hiked. I had several operations to try and realign the knees which helpd some but all lead to ongoing damage. At 1 point the OS suggested removing the knee cap which of course would give me a stiff leg. We went for a 1/2 measure and on the left removed the medial facet of the patella and on the right we had a tibial ostomey to remove some of the pressure on the patella. I should have had the knees done many years ago but I just put up with it and of course every year destroyed more bone. The OS had to resurface both kneecaps with the BTKR, he almost had to replace one of them.

Like the others, you are probably at the end of the road.

A study was just published that doing a scope to just clean things out does not work and there is no reason to do it unless you are fixing torn or floating cartilage.

Good luck. It sure is strange not hearing the knees crunch when bending.

Simon

 

[JudyS]

Thanks everybody.

Jo, why do you think it would be a total? Is there no replacement just for the kneecap?
Simon,
I would not know what to do if my knees stopped making noises!!!

Judy

 

[1jt@atime]

Judy, I remember researching that if the problem was under the knee cap then it had to be a total. The partials are for the medial or lateral side of the knee only and only if it involves one side.

Also, grade 4 is about as advanced as you can get with arthritis. I personally think if it's this bad for you then you better start mentally preparing yourself for the inevitable. We'll trade.... you will become a kneebie and I will become a hippie. Poor us, huh?

**Here's an article that was on MSNBC this week. I think it's the same one Simon spoke about above. The study said a scope is good for someone with recent injuries but not for someone with arthritis.
broken link removed: https://www.msnbc.msn.com/id/26644064

 

[JudyS]

1jt
Thanks for the total verses partial info.
My doc did say he did not think a scope would help. I was certainly not getting prepared mentally for the full. Glad I have a few days before I see him.

I had originally asked my doc if he could replace both hips and knees at the same time!!!!
Judy

Poor us is right, I can't believe I might be moving to the other side!

 

[Josephine]

Jo, why do you think it would be a total? Is there no replacement just for the kneecap?
Judy

It is very rare for arthritis to be confined to JUST the patella. In fact, the patellar-femoral compartment (the 'joint' area where the kneecap rides on the femur) is often the last spot to be affected as it isn't weight bearing. Therefore, total replacement would be indicated as anything less would likely result in a need for revision within a very few years.

**Here's an article that was on MSNBC this week. I think it's the same one Simon spoke about above. The study said a scope is good for someone with recent injuries but not for someone with arthritis.
broken link removed: https://www.msnbc.msn.com/id/26644064

The other reason for a pre-TKR arthroscopy is for diagnostic purposes. Many surgeons still like to confirm xrays, scans and history/observational diagnoses this way as you can't beat a direct visual examination of the joint surfaces. Not everything shows up on scans and xrays.

However, the reason so many scopes seem to fail is because the surgeon is over-ambitious in his desires to 'clean up' the joint. If he does too much debridement, cleaning up rough edges, trimming frayed cartilages and ligaments, all he's really doing is accelerating the effects of the arthritis by doing what it would have done over the next months or even years! And the temptation for him to just go on and on trimming and smoothing is profound.

However, having a quick peek, taking some photographs and doing a really good washout with about 3-5 litres of saline, now THAT is an effective treatment and buys you much time. It worked extremely well for me. I also met a man a couple of years back who had steadfastly refused a TKR for about 5 years but had had washouts (but no debridement) every year or two!

Don't confuse the two and be sure which one your surgeon means when he speaks of 'scoping to improve things'.

 

[JudyS]

thanks Jo,
I kind of want him to go In there and see what is going on. The MRI says there is no other problem area , only the patella. Seemed very strange to me as I have had pain there for over 20 years (on and off).
My hip MRI showed very little arthritis, once he did the scope it was a totally different story.
I should think there should be some wear from 27 years of obsessive running. Time will tell.
I just can't stand the suspense!!

Judy

 

[JudyS]

I went to my hip/knee surgeon on friday. At this point my good (left )knee was joining the parade!!
Cortisone injection in the left knee. It seemed to work immediately. Kind of scarey , but I have had no pain since the injection.
The right knee, we decided to try Hylagan injections next. He still wants my muscles stronger on the hip replacement side!!

I am still trying to figure out if they behead roosters to make the hylagan and how many have to be sacrificed.

Tomorrow it is the spine surgeon. Really tough to maintain this body.
Judy

 

[1jt@atime]

Just tell yourself that they use a syringe to pull the fluid out of the rooster comb! Really, I have no idea......

Judy, I'm with you on trying to maintain the body. We must have gotten the same model. I'm seeing four specialists right now. Hard to keep up, isn't it? Karen

 

[JudyS]

Karen,

I did find out about the poor roosters. Yes, they are killed. I'll probably have rooster dreams.

I know about specialists, I have had 6 for a few years!!
With all the cortisone I've had recently , my endocrinologist would not be happy with me. I just won't mention it.

I have had no pain in my left knee since the injection on friday. I am still amazed. I guess the right one is more far gone!!!
Judy

 

[Gretchendz]

So...my question is...who sits around and thinks...."Let's chop up some rooster combs and inject them in people's knees and see what happens."

Makes me smile thinking about things like that.

 

[JudyS]

I was talking with my 15 year old son about that.
Then my 19 year old daughter. Her reply was that scientists are constantly doing things (such as chopping up rooster combs ) to find new medications . I guess she is right, it still is funny to me.

What can we make for mankind out of pig tails??

Judy

 

[1jt@atime]

What can we make for mankind out of pig tails??

Judy

I'm sure Doug has a few recipes!

 

[JudyS]

Expert knee people
I finished having the 5 hyalgan injections in my right knee. So far no difference. Added to all this is a weird sensation under my knee when bike riding. It does not matter if it is a stationary bike or out in the world. It kind of feels like there is a bandaid stuck to hair and is trying to rip off.
Every time I go up my stairs my knee feels like it separates a tiny bit and finally pops into place. With a loud crack although no pain.

Anyway I am told to give the shots 2 more weeks to see if they will work at all.
Next step would be a scope. When the doc gets in there he will decide if he needs to do a lateral release and or microfracture. Or just wash it out. Also see if under the knee thing is plica or scar tissue.

He does not think a pattello-femoral replacement will be good for me. He said they are for less active people and not as trustworthy as my new hip.

What is your experience with arthroscopies. I do know and we have talked about the fact that knee scopes do not do much good. It is my other knee issues that he thinks could be checked out if I am not happy with the hyalgan.

Opinions, experiece , advice please
Thanks
Judy