Second OS visit with Dr. Papademus at Advanced Orthopedic Associates:
Through out this entire post the first doctor is Dr. Scott Wingerter at Dickson-Dively Orthopedics in Kansas City, KS. The second doctor is Dr. Paul Papademus at Advanced Orthopedics Asdociates in Wichita, KS
Well the wait was long, got there early, getting in the exam room 45 minutes beyond my appointment and then waking another 30 min in there. But he is popular. Long wait meant even longer exam. He took the time to read all the records and labs, looked at xrays, then started exam. He thought the alignment and spacing looked great on the xrays. I was told the same by the first doctor. Had me walk first and commented about the clunking. Then I moved to the table and he checked my ROM followed by stability and a lot of pressing in and around the knee. Had me slide to end of table and let my knee dangle and moved it. Commented about looseness. He said all knees after replacement clunk some, but there is more looseness for this point after surgery than it should be. He didn't focus on the patella as much as he did the looseness. I did ask about the lateral release and the contact the patella was making. He said if all we had was that, then he would do that, but the looseness was concerning him more. He did not like the amount of swelling and felt the instability was contributing in a large part. He agreed that contact was being made and he felt removing the button and replacing would be needed. On the spacer, he did not think a spacer would totally fix the looseness. He said in his experience that would be a bandaid and I might have issues later. Of course until he got in there he wouldn't know for sure. He said at worst case he might need to re check alignment, remove the femoral component and adjust to stabilize the knee. Possibly even the lower component. He also said this is preparing me for the worst case.
He planed to get with my OS and talk about my case. He commented he wished I could wait at least a year out, but he understood where I was at.
So now I have two different opinions. One says release patella, trim bone, replace spacer. The other says a spacer replace may not be enough and may require revision of upper component at least to fix looseness. Less of concern about doing a lot to patella beyond correcting and replacing button. I kept bringing him back to the spacer and patella fix and he kept moving off of it as not being enough.
Now the second guy has maybe 10 more years experience. Comparing the two I see a couple differences.
The patella:
1. The first said to trim knee cap and release
2. The second mentioned nothing about trimming and only agreed to release if I didn't have the significant looseness.
The knee joint and components concerning looseness:
1. The first felt spacer should work and said nothing about component revision as possible route.
2. The second didn't think spacer was enough and I would have issues further down the road. He started by recommending femur component change out and spacer while getting realignment right. He also stated it might require lower component depending on what he found. Preparing me for the worst case possibility. He preferred to wait a yeAr before going back in, but with the pain and swelling that might not be feasible.
So now I scratch my head and wonder who is the most right. I did feel the seconds exam was more extensive. And he did have the added familiarity of already talking to my original OS. In the end he planned to call Dr Hodges and discuss my case further. He also got me the number for his nudes direct line so I could get in sooner for the follow up after he conferred. He said he could do the work, but wanted me to understand that once he got in there it could require more extensive work but would know best once he was at that point.
@josiphine
@Kansas Teacher @Jamie looks like I have a puzzle to figure out.
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