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PKR Patella femoral new treatment suggestion PKR

Ghost Rider

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I was in to see one of the Ortho's I have been interviewing for my future surgery. This whole process has been very difficult. The doctor I saw in July showed me a xray where my right knee showed partial bone on bone. It was clear visible.

Fast forward to yesterday I had those xrays from July on a disc 4 of these I posted below. Yesterdays doctor questioned the bone on bone prognosis but stopped short of saying he was wrong. After more discussion on where I thought the pain was coming from. He suggested a PKR specifically a patella femoral. I started reading a little and these are my symptoms going up and down stairs and getting up and down from my knees. He said it is a much less invasive surgery removing the knee cap and tissue around it. Possibly delaying a TKR for another 15years or so.

He said we could get an MRI to tell for sure. That is until I told the staff person I have a 100% MRI option through my insurance. They tried to scare me into using their in house MRI telling me they called the provider and I was covered at 0% they were not in network and I would be responsible for 100% of the cost. I since found out that that is absolutely not the case all they have to do is fax the order and choose a date, time and facility to go to.

Two days later I have not confirmed that the order was ever sent. The MRI provider called me saying they had called and faxed a request for the order and still nothing but wanted to let me know they are trying to get it. I asked is it obviously because they wanted to perform the MRI and are reluctant to follow up. They confirmed that does happen.

Anyone have more information about this type of knee replacement and looking at my xrays especially the bent knee you can see what to me looks like a bone spur and bend my knees getting up and down this is what causes me pain. Looking at those shots this feels right.

I don't remember any doctor looking more than a few seconds at any xray and saying what do you want to do if the pain is bad enough lets do the surgery you just let me know when you're ready.

I'm no doctor and nor do I know what I'm looking at but if those spurs were ground off might that help my pain?
 

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Celle

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He said it is a much less invasive surgery removing the knee cap and tissue around it. Possibly delaying a TKR for another 15years or so.
A patellofemoral PKR does not remove the kneecap - that would be a really major surgery.
What they do in a patellofemoral (PFR) is remove the damaged cartilage from the back of your kneecap and replace it with a plastic button. They also remove damaged cartilage from the part of your femur where it articulates with the patella, and replace it with a metal implant.

To say doing a PFR could delay a TKR for 15 years is very optimistic.

Currently, some PFRs do well and some do not.
 

Jamie

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Grinding off the bone spurs isn't the answer, even if you could find a surgeon who would do just that. They will come right back as they are a symptom of the problems in your arthritic joint, not the problem themselves.

The most common cause of bone spurs is joint damage from osteoarthritis or degenerative joint disease. The cushioning between the bones in your knee can wear down with age. Rheumatoid arthritis, lupus, and gout can also damage your joints. Bone spurs also can form after an injury to a joint or tendon. Whenever your body thinks your bone is damaged, it tries to fix it by adding bone to the injured area.

Your joint space looks pretty good in the medial and lateral compartments, but it is possible to have arthritis there and it not be bad enough to show in an x-ray. If you decide to try a partial knee replacement, be sure your surgeon does a lot of them (like 150 a year or more) and that he also is capable of going to a full TKR should he discover arthritis in other knee compartments during surgery. This can happen and if you only get a partial, you'll likely be back in surgery within a year or two....or even less.
 

Jockette

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He said it is a much less invasive surgery removing the knee cap and tissue around it.
I have a patellofemoral and it was not the quick and relatively easy recovery I read about. Technically it is less invasive than a total, because they are not doing as much, but it is still major surgery with a lot of disruption to your bones and soft tissue. Healing still takes an average of a year and in my case, way more than a year.

I had the same symptoms you do, pain getting up and down from chairs and going up and down stairs.

I’m sorry to admit I did not do enough research, I trusted the first surgeon I saw and trusted that he knew what was best for me. I also believed I was catching my arthritis early and this partial was all I would ever need.
If you decide to try a partial knee replacement, be sure your surgeon does a lot of them (like 150 a year or more) and that he also is capable of going to a full TKR should he discover arthritis in other knee compartments during surgery.
My outcome has been poor, and I later learned that my surgeon doesn’t do a lot of partials, so it’s no surprise to me that my outcome is what it is, so I agree with Jamie about making sure your surgeon does a lot of patellofemorals.

This is what a patellofemoral looks like. You can see the little oval on the patella where I have the plastic button.

C1C95AE9-FE4E-4EE2-90E2-28C5BB757143.jpeg

Best wishes with your decision. Some of our members have had this type of replacement and done well with it. The key is the surgeon. If you live in a somewhat small area I highly recommend going to a bigger city for a partial, somewhere with a bigger population where they see more candidates for this type of partial. I regret not doing that.
 
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Ghost Rider

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He said it is a much less invasive surgery removing the knee cap and tissue around it.
I have a patellofemoral and it was not the quick and relatively easy recovery I read about. Technically it is less invasive than a total, because they are not doing as much, but it is still major surgery with a lot of disruption to your bones and soft tissue. Healing still takes an average of a year and in my case, way more than a year.

I had the same symptoms you do, pain getting up and down from chairs and going up and down stairs.

I’m sorry to admit I did not do enough research, I trusted the first surgeon I saw and trusted that he knew what was best for me. I also believed I was catching my arthritis early and this partial was all I would ever need.
If you decide to try a partial knee replacement, be sure your surgeon does a lot of them (like 150 a year or more) and that he also is capable of going to a full TKR should he discover arthritis in other knee compartments during surgery.
My outcome has been poor, and I later learned that my surgeon doesn’t do a lot of partials, so it’s no surprise to me that my outcome is what it is, so I agree with Jamie about making sure your surgeon does a lot of patellofemorals.

This is what a patellofemoral looks like. You can see the little oval on the patella where I have the plastic button.

C1C95AE9-FE4E-4EE2-90E2-28C5BB757143.jpeg

Best wishes with your decision. Some of our members have had this type of replacement and done well with it. The key is the surgeon. If you live in a somewhat small area I highly recommend going to a bigger city for a partial, somewhere with a bigger population where they see more candidates for this type of partial. I regret not doing that.
Thanks for sharing your experience. I just don't know if I trust this surgeon. I don't think he does many of these I can ask. When I look at your xray that is not where my pain is coming from, more like below the kneecap.

When I look at my xrays I don't think I see any bone on bone as I look at them, but my knees hurt. However like today I can go on a long 28 mile mountain bike ride. I use neoprene knee braces that stabilizes my knee pads and at the end of the day it hurts to walk up and down stairs as it does sitting and standing. Tomorrow I'll be ready to do it all again but multi day rides will hurt even more.
If I don't ride my L4-5 disc degeneration in my back will start to hurt from inactivity, I'm laid off right now. I would rather have the knee pain.
I know with TKR I can still ride mountain bikes. The thing is getting them done at 56 with an active life like mountain bike riding I can bet on doing them again in my 70's.
 

Roy Gardiner

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I know with TKR I can still ride mountain bikes. The thing is getting them done at 56 with an active life like mountain bike riding I can bet on doing them again in my 70's.
I don't see why not. Mine were done in 2011 and on the bike they are better than they were before. I am confident of continuing to ride.
 
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Ghost Rider

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Here are the results from my MRI don't think I can wait to see the doctor. Anyone have an impression? I don't think it sounds that bad. The 2nd page of both reports does not copy paste well .
Left knee
Small amount of joint effusion is identified along with a tiny Baker's cyst. Mild to moderate tricompartmental degenerative changes are identified. There is mild medial joint space narrowing and marginal osteophyte. The medial meniscus is medially displaced. There is mild truncated appearance and surface irregularity in the inner margin of the posterior horn of the medial meniscus best seen on image #8, series 4 as well as image #18, series 6. Increased PD FS signal within the body of the medial meniscus does not extend to the articular surface and does not represent a tear. ACL and PCL are intact. In the lateral compartment, there is prominent marginal osteophyte and subchondral degenerative cystic marrow signal changes in the anterior aspect of the lateral femoral condyle near the midline best seen on image #18, series 4. Subchondral cysts are also seen in the proximal fibular head. Lateral meniscus is normal in signal intensity and morphology. There is no discrete articular cartilage tear in the lateral compartment. In the patellofemoral compartment, there is irregular high-grade thinning of the patellar articular cartilage near the apex and the lateral aspect. Medial and lateral collateral ligaments are intact. Quadriceps and ...
... Sma~~ tear in the inner margin of the posterior horn of the media~ meniscus. ~~d to moderate tricompartment degenerative changes. B~ectronica~~


Right knee
Moderate tricompartmental degenerative changes are demonstrated. In the medial compartment, there is mild joint space narrowing and small marginal osteophyte. 1 cm area of subchondral degenerative marrow signal changes demonstrated anteriorly best seen on image #16, series 4. Medial meniscus is intact with no discrete surface tear. There is no focal articular cartilage defect. Small loculated fluid near the medial head of the gastrocnemius tendon insertion is identified. ACL and PCL are normal in signal intensity. In the lateral compartment, marginal osteophyte is demonstrated. There is a 2 to 3 cm area of subchondral marrow signal changes in the anterior aspect of the lateral femoral condyle best seen on image #10, series 4 as well as image #8, series 6. Lateral meniscus is normal in signal intensity with no evidence of a discrete surface tear. In the patellofemoral compartment, there is near full-thickness patella articular cartilage loss laterally. Medial and lateral collateral ligaments are intact. Quadriceps and patellar tendons are normal. Visualized musculature demonstrate no evidence of edema or fatty infiltration. IMPRBSSION: PAGE 1 Signed Report Printed From PCI (CONTINUED)

HOderate tr~compartmenta~ degenerat~ve changes ~nc~ud~ng subchondra~ marrow s~gna~ changes as we~~ as marg~na~ ostaophytes ~n the med~a~ and ~atera~ co~artments. There ~s near fu~~-th~ckness art~cu~ar cart~~age ~oss over the ~atera~ pate~~a. No d~scret. tear ~n the men~sc~. B~ectron~ca~~y S~gned By: ,
 
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Ghost Rider

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Google is your friend, may be somewhat bad.

Tricompartmental osteoarthritis occurs when all three compartments in the knee are affected by arthritis symptoms. The condition causes degenerative changes in the joint. Because of its widespread nature, tricompartmental osteoarthritis may be more severe than other forms of osteoarthritis.

Reference Medical News Today, "What to know about tricompartmental osteoarthritis" by Jon Johnson, May 18, 2018
 
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Jaycey

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@Ghost Rider It's OK to quote something off another page but can I ask that if you do this you sight the reference? I edited your post to reflect this. It's just polite to give credit to the original source. Thanks!
 
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Ghost Rider

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I think this was it it , sorry for my omission

 

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