OS says a patellectomy vs PFJR for pain relief. Isn't this an old procedure?

[heather_rae]

Hi all!

I started on this nasty pain dilemma when I shattered my patella into many, many fragments in 5/07. It was a near save, but it was repaired with hardware that was later removed. Unfortunately, I chewed up the PF compartment pretty badly when the knee hit the dashboard. I also had profound muscle wasting from the hip to the ankle during the healing process. Surely, having to wear the full length brace for several months didn't help either.

It's been ALOT of rehab since 7/07 and I'm still not done. My PT says the pain from the cartilage damage behind the knee is inhibiting proper quad functioning. He's gone as far as we can without other interventions. He feels the quads won't fully come back otherwise and the pain will continue. I agree because it's not getting better. The rest of the leg is looking fairly good and has some rebuilt muscle tone/strength/mass.

I recently saw an OS that my OS referred me to see. He took an X-ray, which wasn't the standard type. It's pretty detailed. And yes, the areas of good cartilage in the medial and lateral compartments appear white as the darkened, black areas are on the patella itself as well as behind it on the femur. There's no space in between the kneecap and the femur either. He agreed with my OS's diagnosis of patellofemoral arthritis. There is still pain with every step I take and standing still is murderous after a few minutes!

His solution is to keep rehabbing, only with his PT now 1x/week. I'm stuck in a rut but, I hope he soon figures out what my PT has been saying. If the pain doesn't get better, he said he'll just remove the kneecap. Think I'd lose even more functioning after that. I'm leary because he said I may need a joint replacement later on. I've read that a patellectomy is an outdated procedure versus what they're doing now... the PFJR. Should I seek another opinion? Or does anybody know why he would use an older technique for this? Any and all comments would be greatly appreciated!!!

Thanks: Heather

[Silkncardcrafts]

Hi Heather,

Removing your knee cap is a last resort. It makes it that much more difficult if you need a replacement later on.

I was at my witts end last year and my OS said having the patella removed was not an option as it could still cause problems.

Maybe you need to get another opinion.

[Sandy_F]

I had a patellectomy. I would avoid it if at all possible. Once you have it done you lose about 30 - 40% of your quad strength and most likely will not get full extension back. It is a very drastic surgery. If I had known the long term ramifications of the surgery I would never have consented to have it done. There are OS that will not touch a patella-less knee to do a TKR on it. So I would think long and hard before I would go this route. I would get more opinions and make sure that you know what you should do and what the consequenses of the surgeries are.

There are a few doctors that are replacing the patella. Maybe look into that. I know a doctor in Baltimore, MD at Sinai Hospital has done that procedure. I ended up still needing a TKR and had an experimental procedure done. I had a piece of bone that was removed for the prothesis put inside the patella tendon. That simulated a small patella. It has helped the knee mechanics a bit but I still have problems with the TKR. So the patellectomy has life long ramifacations that I have not been able to overcome.

I can't tell you what to do but I can recommend to get multiple opinions and to seek ways to help your knee without going the patellectomy route.

[heather_rae]

Thanks sooo much for confirming this with me you guys.. I really am scared and I'm VERY tired of pain 24/7. I have e-mailed a doc who specializes in PF problems about 2 hours from here who is wlling to review my x-rays before determining if I should schedule with him. What a relief!! So, I am taking your advice about various opinions from other docs and weighing my options.

About the quad strength, my PT feels that a better bracing option rather than the lateral J I've had since May might help the PF pain and result in stronger quads. It's called Protonics. Since the doc wants me to see his PT now, I'll be passing that along tomorrow. Well see... As you guys must know, anything to ditch some of this pain even if it's a bulky and cumbersome brace.

Guarding this nasty old beat up kneecap with my life now. You're absolutely right it's mine and it WAS saved no matter how bad it was, right? Thanks a bunch!!!

Heather

[Jimb]

Not for nuthing but I think it would be a good idea to get another opinion. The patello is what stablizes the knee and removing it could make it go out at the drop of a hat.

I would think the PFJR would be the more desired choice.....

[heather_rae]

Hi Jimb:

So, I've read here, it seems you've ran through the gamut with your knee too. OH boy, and then a TKR to boot. Hope all is good now.

All this while I've been in therapy, the PT has been saying the patella is the lever to the quads. He's a pretty smart cookie. Think you're definitely right, a patellectomy would cause a slippery downward slope and I don't have much to work with right now.

I'm shooting my x-rays off in the mail to this other doc. Very anxious as to what he'll say. In his return e-mail to me he said if I have enough bone stock to work with, a PFJR would be a success. The only thing that perplexes me is if it would work with the lateral maltracking going on. If not, I sincerely hope I am not told to just live with the pain. I just want my life back.

Thanks to everyone for the thoughts/encouragement about the 2nd opinion. The x-rays are going out in the A.M. Fingers crossed! If you're curious about the doc, he's on Patella MD.com. I'm very grateful he is willing to do this without seeing me first! Not alot of OS's would even consider it, ya know? Take care and have a great evening KG's!!

Heather

[FormerlyActive]

Hi Heather
I know some people on KG have had the patellectomy, so perhaps do a search and read their old threads or even PM them. Does sound like something to avoid, perhaps the partial knee wasn't an option when other people had it done. Or wasn't an option for their situation?

It does seem like the key question is what type of shape is your patella in? and it does appear more opinions are warranted. Don't let that scare you, you have a complex situation and are considering some serious surgeries, so learn whatever you need to learn. Are you able to find any additional articles on any of the options?

If you go back to the OS, would ask him why he is considering the patellectomy vs. partial knee and under what conditions (decision points) he would recommend either?

Perhaps the braces you mention would help with a good position while you are walking etc. without additional compression. Let us know how it goes.

Best healing wishes.

[Heathers_new_knee]

Hi!!!

Thanks for posting! The OS who offered to look at my x-rays is a patellofemoral specialist so, I have my fingers crossed. Still waiting to hear what he has to say about options to ditch this pain.

I had a VERY interesting PT session with the new one last week. The guy nearly killed me, LOL! He works hand in hand with the new OS I've just seen so, I called the OS office because I was down for 3 days and couldn't bear weight on it without buckling. It felt like the post day #1 after the MUA I had one year go!!

If anybody has a better idea about bracing (other than the lateral J that I have now) please post back. Seems that something better to unload the forces on the PF joint might help. I have horrible knee pain while attempting SLR's that almost brings me to tears and the quads seem to be working now, I can feel them tighten with my hand. So it seems, anything that brings the femure and patella into contact like that makes me see stars!!

Thanks again....

Heather

[FormerlyActive]

Hi Heather
Haven't heard from you and just wondering how you are? Were you going to see that new OS soon? How is the new PT going, what do they say?

Post or send me an e-mail. Hope you are doing ok. Best wishes