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Osteolysis in Patellar Component of TKR

Florida75

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Hello Everyone. I am new to the forum but have cruised this site for info many times before. Figured this would be a good place to come and talk to others about my current situation. I am 44 and got my L knee replaced when I was 27 in 2002 due to a horrible car accident I was in when I was 26. I had fractures to both the tibia and femur which required rods and tibial plate being placed but a year later the leg was so crooked and causing me pain that my surgeon thought it was best to replace the whole knee. I have a non cemented knee with a resurfaced patella. In 2015 I had to have the patella revised due to osteolysis and had a bigger spacer put in. I was experiencing pain on the inside lower portion of my knee.

About a year and half ago I started to experience the same pain again. My OS who did the patella revision said the x-rays looked fine and to work on my strengthening of the leg. I went back 6 months later due to the pain getting more severe and he said the same thing. I called him shortly after and asked him to order PT for me to work on my strengthening and the pain is not any better. I got a second opinion from an OS that ordered an MRI which shows "lobulated areas of osteolysis in the patellar component" and a "firmly fixed tibial and femur component". That OS said I should have had the whole knee replaced four years ago and currently the only hospital he works out of does not accept my insurance.

So needless to say I am disappointed in my old OS that didn't want to further investigate the pain in my leg and that this has been going on for so long. He is now down in south Miami and my research shows that he does specialize in revisions but I'm not really interested in dealing with him. I don't know if I am over reacting but I have sent my records to the Hospital for Special Surgery to try and get an appointment. I am really nervous to have long term problems with my leg and want someone who absolutely knows what they are doing if and when they go back in there.

I can't really find much info on osteolysis in the patella issue. Not sure if anyone else has experienced this but I figure I would ask. I also am very nervous about the future...more surgery.... trying to finish up my last semester of school but feel this is probably something that should be taken care of sooner than later. Hoping I still have some of my knee cap remaining moving forward and afraid of my options if I don't.

Not sure if anyone has any recommendations on an OS that is in Florida that would be worth going to see. I appreciate any feedback and thanks for listening...glad I can some somewhere and vent where people understand.
 

Pumpkln

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@Florida75
Welcome to BoneSmart, glad you joined us.
Sorry to hear you are having challenges with osteolysis of your knee cap. It is an uncommon experience.
@sistersinhim has had both kneecaps removed and has a TKR.

You can start your search for an OS in Florida by using our surgeon locator in the blue banner at the top of the page. @Jamie may also be able to help you locate a surgeon that specializes in revisions.
 

Jamie

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Unfortunately, although I could help you find surgeons in Florida, I have no way of knowing their experience with osteolysis. If you have the option of seeing someone at HSS in New York, that may be a better option for you. But, I am happy to help you with names of surgeons in either location that you can contact and find out whether they have expertise in this area or not. Your chances of finding someone are better at HSS, I believe.
 
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Florida75

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@Pumpkln
Thank you for the reply. It is an uncommon issue which makes me even more concerned. lol. Better to have a problem people and surgeons have more experience with than not right? I am sure it will all be fine and thought this may be a good place to try and find others that have experienced the issue or just patella issues in general.

@Jamie Yes I would love some recommendations for OS in Florida. I reached out to Dr. Cross at HSS. I am not sure about his experience with osteolysis, although I did see it was something he had listed under one of his areas of interest. I sent my records to them last Monday and will be placing a follow up call tomorrow to see if they have been received.

Thank you both for your kindness:)
 

Jamie

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Here are a couple of recommendations I have for Florida surgeons. I've also included a link to a helpful website that allows you to see the number of surgeries Florida doctors perform.

Orlando, Florida

Dr. George Haidukewych, MD
* Recommended by Brian (Orthodoc) for difficult revisions and infections knees and hips
Orlando, Florida He does one and two stage revisions. Good with infections.

Orlando Health
1222 S. Orange AVE
5th Floor, MP 43
Orlando, FL 32806
Phone: (407) 649-6878

Internationally recognized for joint replacement surgery and trauma, George J. Haidukewych, MD, serves as director of orthopedic trauma, chief of complex joint replacement, academic chairman for the Orthopedic Faculty Practice and professor at the University of Central Florida College of Medicine. He trained at the prestigious Mayo Clinic in Rochester, Minn.

Dr. Haidukewych specializes in total hip and total knee replacements as well as orthopedic trauma. He brings extensive experience in the management of failed and infected total hip and total knee replacements and in reconstruction of the joints after trauma.


Jacksonville, Florida

Dr. Kurt Blasser
Mayo Clinic in Jacksonville, Florida
Primary and revision hip and knee




Link for Florida surgeons to see how many hip/knee replacements they do a year.

Physician Volume
 
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Florida75

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@Jamie Thank you for this useful tool. I have been looking for something like this. Would you happen to have a link which shows this for the doctors in NY? I will also look into the recommendations you made for the Florida doctors.
 

Jamie

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To my knowledge, Florida is the only state that has a tool like this. You can look up doctors and hospitals at ProPublica (be aware the data is based solely on Medicare input), but it doesn't have the same detail.

https://projects.propublica.org/surgeons/
 

jboles

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What is osteolysis, if you don’t mind me asking? There was a mention of this on my last X-ray.
 
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Florida75

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It’s where your bone starts to reabsorb and attack itself. From the HSS website....“wear debris” from the breakdown of materials in the hip or knee implant can accumulate in the surrounding tissues. This causes local inflammation that destroys the bone and loosens the prosthesis, a condition called osteolysis.”
 

jboles

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Thanks for the explanation. Not something that I want to hear, considering it’s not been 6 months since my revision :scare:
 

VSlowLife

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@Florida75 I thought you may be interested in this: Complex Joint Reconstruction Center at HSS. It’s a special program where a committee of surgeon meets to discuss you case. It’s not for a primary replacement surgery, but for a replacement surgery which has become a problem. There is a $500 fee, and this center I believe is run by Dr.Thomas Sculco, who seems to be easing his way out of surgery as his son, Dr. Peter Sculco has been launching his career at HSS. I had called them.
 
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Florida75

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@jboles Hi. I am sorry to hear that you have osteolysis in your revised knee. I wanted to wait before I commented due to having an appt with my OS this past Friday. I have osteolysis in the knee cap and in the tibial component of my knee. Apparently the knee is stable and not loose so they monitor the osteolysis via X-ray or MRI and when the pain gets unbearable or the joint gets loose that is when he will do the revision. Honestly it feels a little funny to know this process is going on inside of my leg and not doing something about it but I guess the risks of having another surgery are more worrisome. What is going on with your knee if you don’t mind me asking?
 
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Florida75

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@VSlowLife. Thanks so much for the feedback. I actually sent my records up to Dr Cross at HSS who is part of the team (I Believe) and he said I was not a surgical candidate at this time. His office staff didn’t offer any info as to why but after meeting with my local orthopedic doctor I believe it is because the implant is not loose. I do have the osteolysis which apparently you just monitor until it causes too much pain or affects the stability of the joint.

Thanks again for the info though...it is always good to know for the future if need be.
 

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