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[TKR] Patella tracking problem

Discussion in 'Knee Replacement Recovery Area' started by LinaDi, Jan 12, 2017.

  1. LinaDi

    LinaDi New Member
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    I am almost six months post surgery and had been progressing well, have full extension and 121 degrees of flex. No PT for the last four months until mid-December. I went to visit my daughter the first week of December and was going up and down steps in their house (we have no steps in ours). I noticed a looseness in my kneecap, especially when going down stairs.

    To investigate what was happening, I sat on a chair with my left leg fully extended in front, then when I started to bend it the patella "jumps" to the outside by almost a good inch! But my tibia also shifted so that as the patella went left, the tibia turns inward. I called my surgeon's office and was told to go the PT route for a few weeks. PT says it could take many months of specific exercises to strengthen the inside muscles and keep the kneecap in place. This does not feel right. I was also advised to use physio tape (KT) which I have been applying according to knee instructions.

    I am now visiting family in Europe, walking a LOT and the knee is getting worse. I have read as many threads on this subject that I could find.

    Prior to travel, I was getting around well, riding my bike around, taking short, easy hikes. I'm very concerned about this setback. It feels like something is misaligned. We return home to routine and work on Sunday.

    Any advice would be deeply appreciated.
     
    Last edited: Jan 12, 2017
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  2. L.I.T

    L.I.T Senior

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    @LinaDi, I'm so sorry you are having this issue - it's definitely a disconcerting feeling!

    I have done a lot of research into this, as I have been having a similar issue (although have not noticed my tibia was shifting). But I'm only 3 weeks out. From what I can discern, it's either an issue of misalignment of the implants... Or it is caused by intracapsular swelling of the soft issue and/or quadriceps weakening.

    Mine I feel relatively certain is the intracapsular swelling, as I had a similar issue post knee scope 2 years ago. For some reason, my kneecap is just really sensitive to any amount of swelling.

    The one thing you might consider is if you have been doing more activity now than before - and if there *might* be extra swelling somewhere under the kneecap. Otherwise, I suppose a visit to the OS would be in order for an xray or CT to find out if something has shifted or loosened.

    Good luck!
     
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  3. KarriB

    KarriB Forum Advisor

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    I'll tag our forum nurse, @Josephine . Did your OS see you or take x-rays? You may need to find an ortho who specializes in revisions as they are experienced in finding issues with implants.
     
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  4. LinaDi

    LinaDi New Member
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    Thank you, L.I.T. and KarriB.
    I have not yet seen my OS or had any imaging done yet. Still away from home but getting worse so I thought I'd put it out to the community. I look forward to some other thoughts.
     
  5. Pumpkln

    Pumpkln Forum Advisor

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    LinaDi,
    While you are away, make an appointment with your OS, you want to see them ASAP when you get home. You will also want to start looking for a second opinion with an OS that specializes in revisions, they have the education and experience to determine what is going on with your knee. In the meantime avoid over doing, rest, ice, elevate, and medicate as advised.
    Keep us posted on how you are doing,
     
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  6. LinaDi

    LinaDi New Member
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    Thank you, Pumpkin! I will make an appointment with my OS but have a different insurance for this year and will need to wait until Monday! :-/
     
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  7. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    I also suggest that you stop walking so much. I know you look like a lady who enjoys walking and hiking but it's not doing your knee any good right now. Patellar dislocation isn't that common but it does happen and if the kinesiology tape and physio doesn't help then some remedial surgery might be necessary to realign the patellar tendon. These can include
    1. reconstruction of the medial-patello-femoral ligament
    2. Tibial Tubercle Transfer - moving the insertion of the patellar tendon on the tibia
    Both these hold the patella and stop it dislocating.

    1..........................................................2.
    MPFL.jpg tibial tubercle and patellar tendon.JPG

    A TTT looks like this
    hauser.jpg
     
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  8. LinaDi

    LinaDi New Member
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    Thank you, @Josephine. I appreciate your help. My OS office called me back but need to call me again. Waiting. Meanwhile, I'll stop walking and will get my OS appointment set up. I'll let you know what happens next! Not happy this is happening.
     
  9. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    I would be sincerely surprised if you were!
     
  10. LinaDi

    LinaDi New Member
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    Yes. No need to state the obvious here! Because of my new health insurance, I can't see my OS at all. :-(
    Onward to figure this out. Has anyone had a complete re-do because of patella tracking issues?
     
  11. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    To be honest, it's actually not that common. I do know of a research project under way in the UK, looking into the problem and testing whether PT or surgery would be most effective. Sadly it's only just begun and since the follow-ups are going to continue for 3 years, it won't be of much use to you. But I mention it just to show that it is a recognised problem.
     
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  12. Giantstu

    Giantstu Junior Member

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    Hi I am sorry to jump in on this thread but @Josephine do you know where the location of the research in the UK is please, as I am going through same issue but have already had a TTT and mfpl which has not worked so grasping at straws.
     
  13. newlybionic

    newlybionic Forum Advisor

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    I went to revision specialist to fix my knee. My patella was off to the outside of my knee and I was experiencing a lot of pain and losing range of motion. There were some other issues present within my knee. I had a complete revision and I'm doing very well.
     
  14. Jamie

    Jamie Administrator

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    Jo is off the forum for a bit on a holiday, but she will be returning soon and should see your tag.
     
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