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Kneecap Dislocation

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BigRed

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I am scheduled to have bilateral TKR in June. Last weekend I dislocated the kneecap of my right knee. This is not the first time this has happened. I have had patella femoral syndrome in both knees from childhood. I had two surgeries on my right knee many years ago to stabilize my kneecap but they were not very successful. I have had multiple dislocations of both kneecaps over the years. My last kneecap dislocation was a little more than two years ago.

This recent injury has made me very nervous. I expect that the knee replacements will give me some pain relief from arthritis pain but will the surgery help to stablilze my kneecaps too? I just assumed it did since I was getting "new knees" but now that I think about it I am not getting new liagments and tendons too.

I would love to hear from others who had a history of kneecap dislocations and how they are doing after TKR.

Thank you.
 
BigRed, your question is a good one for Josephine. She should be checking in a little later when the sun comes up in Great Britain.
 
Gee, thanks, Jamie!

Well, BigRed, that's a good question but one, I think, that you needn't worry about. There are several issues that contribute to unstable patellae and the placement of the ligaments is just one. The others are a shallow tracking groove between the femoral condyles and a patella that's too thin or otherwise malformed.

When you have your knee done, the prosthesis will replace the intercondylar groove and the button with increase the thickness of the patella. This should not only resolve the tracking problem but also give some extra tensioning to the quads/patellar ligament.

So before you have your knee done, I suggest you have a good discussion with your surgeon and get him to lay out his plan of action regarding this problem so a) you can assure yourself he actually has one! and b) you know how it's going to be resolved.

Hope this helps some.
 
Very interesting question and answer.

My 25 year old daughter has one of those knee caps, she has dislocated it about 3 times. Now when dancing she always wears a knee brace (elastic). One PT told her it was because her muscles etc were stronger on one side so it pulled her knee cap out, and to build up the other side but I'll tell her now there are other reasons it could happen.

I'm not much help to you BigRed but thanks for asking the question and best wishes for your surgery and recovery.
 
Thank you for the responses. I have had more than 20 dislocations between my two knees over the years. I have learned to live very carefully as I matured to avoid or at least limit the dislocations. This latest injury was so disconcerting because I didn't slip or fall causing the dislocations as usually happens. I simply went to sit down and as I did the kneecap dislocated.

Josephine, you gave me new information that is comforting. I had been told as a child that I grew too tall, too fast and so my ligaments were stretched to keep up with the bone growth. When I was 19 and again 24 years old, I had full open-knee surgery to clean up all of the bone splinters and to shorten tendons to try to hold the kneecap in place. Unfortunately, it was somewhat overcorrected and so my right kneecap dislocates inwards while my left kneecap (that was not corrected) dislocates to the outside. Now that I know that the prosthesis can improve the tracking, I can ask better informed questions of my doctor. Thank you so much.
 
I had never heard of a dislocated kneecap. Is this essentially the patella jumping out of the track?

From what I have seen of the replacement, both the inside of the patella and the track are completely replaced.
 
Essentially yes, Gringo. And you are correct - the track and articular side of the kneecap are replaced (wasn't that what I said?)
[Bonesmart.org] Kneecap Dislocation


When you have your knee done, the prosthesis will replace the intercondylar groove and the button with increase the thickness of the patella.
Click to expand...
 
When my kneecap "jumps the track" it really does a good job of it. I often (several times a week) feel my kneecap wobble but when it dislocates it moves all the way to the side of my knee. Sometimes it goes back on its own. Sometimes it has to be manually put back into place. It is always painful.

My knee is very weak right now due to the injury. I am not able to lift my leg. Has anyone had their TKR while still recuperating from an injury? Might it cause complications or a delayed recovery?

Of course, I plan to ask this of my doctor but I would love to hear from people who have been through it.
 
Hi just want to say welcome. Sounds like you hve been thru alot for a long time. I think you will benefit alot from your surgery. Hang in there. Keep us posted and I hope you feel better soon. ..........Kim
 
Hi BigRed, and welcome!
I can't offer any advise but want you to feel welcomed to this site. You've found a very caring group of people who will be there with experience and friendship to help you through this experience. I, too, am having BTKR. My surgery is May 18 so I'll be a bit ahead of you. While you wait, spend some time here and take extra good care of yourself.
Blessings,
Irene
 
I've seen dislocated patellae and it's not a pretty sight. You have my sympathies. Under normal circumstances I would advise you to do some quads strengthening exercises but it seems inappropriate here. However, I'm sure you'll be fine so long as you commit yourself to the PT afterwards.
 
BigRed

I also have patella subluxation (they never totally dislocated but like you would go off to the side on a fairly frequent basis). This started in high school and I learned how to pop them back into place, nothing like having on go out when you are backpacking and 10,000 feet up a mountain. I had several surgeries between the 2 knees to try and stabilize them most work for awhile but it wasn't till I stopped playing sports and hiking did they settle down.

I had BTKR last June and everything went fine and they have not moved since. In fact, the right one because of all the surgeries and moved around tendons and ligaments plus scar tissue was so tight the OS could not flip it (normal procedure) to move it out of the way while working on it. It took them almost 45 minutes to figure out a way to get it off to the side. The left one was a bit easier because the medial facet had been removed so they had more room.

So, the TKR should solve the problem, it did for me.

Simon
 
Yes, I can imagine that would have been a problem, Simon.
[Bonesmart.org] Kneecap Dislocation

 
Thanks again to all who replied.

I am healing okay from the most recent dislocation. I am still in a knee brace with an immobilizer over it but when I am non weightbearing I am taking them off to try to get the knee bending again. It is VERY unstable if I try to step on it without the immobilizer, even wearing the brace - but I have to remember the injury was only two weeks ago. I am just anxious because I was working hard to build my muscles prior to my late June surgery and now I am unable to do so just yet.
 
BigRed, Glad to hear you are improving. Take care of yourself and baby that leg. Can you do some of the basic quad exercises while lying or sitting without problems? Like extending your leg and flexing the quad and releasing it? If so, that will help you even while you are unable to walk well and exercise.
 
Ok this is maybe a dumb question, but when you get the tkr do you not get a kneecap? I was told I would be getting a kneecap
and knee. My horse threw me at a show several (several severals)
years ago and messed up my back and knee and kneecap so guess
thats why.
 
I think it is pretty routine to put what they call a "button" on the kneecap when a TKR is done. Jo would have to provide more details of exactly what is done. But I do know the surgeon has options as to what is done once they get inside and see what is really going on. That is one reason why the skill of your surgeon is sooooo important.
 
Thanks Jamie
I saw what they where going to put in and it is about the size of
a kneecap. I know mine looked really bad in the xrays even to me.

Yes you are right on the skill of the surgeon. The one I used is
really good and very highly thought of. Doctors go to him and
they come from out of town to use him. Hard to get in but
I was luckly one of my doctors is a friend of his.
 
The way my crazy Dr was no telling what is behind my knee cap, silliy putty, glue, play dough who knows !!!!!!!!
 
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